Psychopathology

Question 1

State 4 definitions of abnormality

Answer 1

• deviation from social norms
• statistical infrequency
  -failure to function adequately
• deviation from ideal mental health

Question 2

Define social norms, name 2 types

Answer 2

• norms that are created by society- they are acceptable standards of behaviour set by a social group
• the people who live in this group adhere to and follow these social norms and anyone who doesn’t, who deviates from the social norms, is seen as abnormal
• social norms will vary across cultures, situations, ages uneven gender- So what is acceptable in one of these situations will not be in others. One important consideration is the degree to which a social norm is deviated from and how important society sees that norm as being
• explicit and implicit

Question 3

Implicit vs explicit social norms

Answer 3

• an explicit social norm is one that is a written rule or law, for example that we do not use our mobile phones when driving. With reference to abnormality somebody who is depressed or agoraphobic may not to leave the house and therefore not attend school- goes against the written rule in UK society that’s all children under the age of 18 should be attending full time education
• an implicit social norm is not a written rule, but one that we tend to follow such as eating dinner with cutlery. With reference to abnormality somebody who is suffering from OCD may perform compulsive behaviour such as having to turn a light switch on and off a high number of times. Goes against the social norm of just turning a light switch off once.

Question 4

Strengths of deviating from social norms

Answer 4

Practical applications:
- can be used to identify people who need psychiatric help. For example, the behaviour of someone who hears voices differs from the norm, so they would be likely to be diagnosed as schizophrenic, and to receive treatment.
- the key defining characteristics of anti social personality disorder is the failure to conform to culturally acceptable ethical behaviour such as recklessness, aggression, violating the rights of others and deceit fullness- these signs of the disorder are all deviation from social norms
- this is a strength as it shows how the definition can be used to help improve someone’s quality of life- has value in psychiatry

Question 5

Weaknesses of deviating from social norms

Answer 5

Social norms vary between cultures:
- social norms change between cultures and overtime- consequently, peoples definition of abnormality will not be constant
- for example, homosexuality was regarded as a mental illness until 1973, but not anymore. Cross cultural misunderstandings are common, and may contribute- for example there is a high diagnosis rate of schizophrenia among non-white British people
- hearing voices is normal in some cultures as messages from ancestors, but would be seen as abnormal using UK standards
- weakness as it can’t lead to a universal definition across all cultures and times

Context dependent:
- classification of abnormality is based on the context in which the behaviour occurs
- for example some behaviour might be normal or abnormal in different contacts like undressing in a bathroom or a classroom, or aggressive and deceitful behaviour in the context of family life is more socially unacceptable than in the context of corporate deal-making
- weakness as it means a level of subjective judgement is required- can’t be objective measure of abnormality

Ethical/human rights concerns:
- the definition raises ethical concerns as people who don’t fit into society’s norms are often labelled as abnormal, and may even be institutionalised. For example, young unmarried mothers in the past were often locked up in mental institutions because their behaviour was seen as unacceptable.
- historically this has been the case where diagnosis like nymphomania (womans uncontrollable or excessive sexual desire) have been used to control women, or diagnosis like drapetomania (black slaves running away) where a way to control slaves and avoid debate
- suggests but the definition is linked to issues of social control

Question 6

Describe failure to function adequately as a definition of abnormality, and give two examples

Answer 6

• an individual who is failing to function adequately and unable to continue with their normal everyday activities, such as going to work, washing, or taking part in social activities, would be considered abnormal using this definition
• day to day living is difficult for these people, they may feel as if they cannot go to the shops or to a friends birthday- failing to function adequately is a general sign of having a mental illness and is not specific to a disorder
• agoraphobia- may stop someone from having social interactions normally, may struggle to find a job, may struggle going to the shops, may find it hard to maintain relationships
• depression- may find it hard to get out of bed, have personal hygiene, exercise, socialise etc
• e.g. intellectual disability disorder- would have a statistical infrequency of a very low IQ, however they must also be failing to function adequately before a diagnosis would be given

Question 7

Who proposed features of failing to function adequately

Answer 7

Rosenhan and Seligman (1989)

Question 8

Name and explain the features of failing to function adequately that Rosenhan and Seligman proposed

Answer 8

Observer discomfort:
- when a person’s behaviour causes distress and discomfort - for example OCD- having repeated behaviours may distress others

unpredictability:
- we rely on behaviour around us to be predictable, so if a persons behaviour seems unpredictable and uncontrolled it suggests there is something wrong
- e.g. OCD- someone may repeat things or take a long time in certain places in an unpredictable nature

Irrationality:
- we can usually interprets the behaviour of others as being rational, but if the behaviour does not seem to be rational and hard to understand it’s can suggest there is a problem
- e.g, OCD- repeatedly getting compulsions to wash things that are clean, or checking locks that are shut

Maladaptiveness:
- behaviour which is not helpful or adaptive, limits the ability of a person to adjust to a particular situation
- e.g. depression- sleeping too much or staying in bed may stop you from daily tasks

Personal suffering and distress:
- when the inability to cope with everyday life causes personal distress and suffering to the individual themselves
- e.g. depression - suicidal thoughts/ideations

Question 9

Strengths of failing to function adequately as a definition of abnormality

Answer 9

Takes individual experiences into account:
- this is because we view the disorder from the point of view of the person experiencing it
- this definition has sensitivity as it considers the subjective experience
- this supports the failure to function adequately as if other people are solely responsible for deciding whether someone is abnormal this can be interpreted subjectively depending on the person who is deciding
- therefore the individual may not feel as though they are suffering from a mental illness when someone else says they do- less likely to happen with the failure to function adequately definition
COUNTER- SUBJECTIVE:
- someone has to judge if the patient is distressed or distressing others
- some may say they are distressed but may be judged as not suffering
- there are methods for making judgments such as the global assessment of functioning scale, however the psychiatrist has the right to make a judgement

Easy to judge:
- easy to judge who is considered abnormal according to this definition
- e.g. The DSM V uses the wells health organisation disability assessment schedule 2 (WHODAS 2.0) which is a patient self report assessment tool that evaluates the patients ability to perform activities in six domains of functioning over the previous 30 days- each item is rated on a scale of 1 to 5 and the individual is given an overall score out of 180, this school represents global disability- the areas are understanding and communicating, getting around (mobility), South care, getting along with people, life activities and participation in society
- this supports failure to function adequately as if we have an objective judgement of abnormality, we are more likely to have a reliable diagnosis of abnormality

Practical application:
- can be used to identify people who need psychiatric help.
- for example, if someone could not get up for work, or feed themselves, they would be diagnosed as depressive using this definition and would get treatment
- can help improve peoples quality of life

Represents a threshold for help:
- one strength of the failure to function criterion is that it’s represents a sensible threshold for when people need professional help.
- most of us have symptoms of mental disorder to some degree at some time- according to the UK mental health charity mind, around 25% of people in the UK will experience a mental health problem in any given year
- however, many people press on in the face of fairly severe symptoms- tends to be at the points that we cease to function adequately that people seek professional help or unnoticed under refers to help by others
- this criterion means that treatment on services can be targeted to those who need them the most

Question 10

Weaknesses of failing to function adequately as a definition of abnormality

Answer 10

Relative to culture:
- definition is culture specific
- ideas on adequate functioning are related to a cultures idea of how life should be led- if these ideas are used to judge a person from another culture or subculture, problems arise
- Escobar (2012)- has pointed out that white psychiatrists may tend to over interpret the symptoms of black people during diagnosis- such factors as cultural differences in language and mannerisms
- weakness as limited definition as can’t lead to universal definition of abnormality applicable to all cultures

Behaviours can be normal but maladaptive/ threatening to ones self:
- for example adrenaline sports, smoking, drinking alcohol and skipping classes
- shows the factors can’t offer a complete definition of abnormality

Not reliable definition:
- Star Wars the definition isn’t reliable as not all abnormal or disorders people will feel personal distress
- for example, people with anti social personality disorder/ psychopaths do not feel guilt and therefore can harm or kill others without it causing them distress as in the case of Harold Shipman
- suggests that the definition can’t be generalised to all areas of abnormality

Discrimination and social control:
- it is easy to label non standard lifestyle choices as abnormal
- in practise it can be very hard to say when someone is really failing to function and when they have simply chosen to deviate from social norms- for example not having a job or permanent address might seem like failing to function, and for some people it would be. However, people with alternative lifestyles choose to live off grades. Simply those who favour high risk leisure activities or unusual spiritual practises could be classed, unreasonably, as irrational and perhaps a danger to self
- means that people who make unusual choices are at risk of being labelled abnormal and their freedom of choice may be restricted

failure to function may not be abnormal:
- there are some circumstances in which most of us failed to cope for a time for example bereavements
- it may be unfair to give someone a label that may cause them future problems just because they react to difficult circumstances
- HOWEVER, the failure to function is no less real just because the cause is clear comma also some people need professional help to adjust to circumstances like bereavement

Question 11

Describe statistical infrequency as a definition of abnormality

Answer 11

• defines abnormality as behaviour that deviates from the average, thus the less often the behaviour occurs (statistically), the more likely it is to be abnormal. Therefore the majority of people are normal and a minority are abnormal
• the concept of normal distribution is used to decide which behaviour is statistically normal and which is statistically abnormal
• this explanation only refers to characteristics that are normally distributed, which the ‘big five’ personality characteristics are- and mental illness is thought to be extremes of these traits.
  The big 5 personality characteristics:
• Openness (curious, creative, open to new ideas)
• Conscientiousness (organised, achievement orientated)
• extraversion (outgoing)
• agreeableness (sensitive/ trusting)
• neuroticism (anxious/ irritable)

Question 12

What measure is used in statistical infrequency as a definition of abnormality,describe this, graph

Answer 12

• Standard deviation- a measure of dispersion which shows how far spread out the data is from the mean
• the majority of characteristics cluster around the mean and approximately 68% fall within one SD of the mean
• approximately 95% of people fall within 2 SD of the mean
• this leaves 5% of the population who fall 3 SD from the mean- it is these 5% that are considered statistically abnormal
• applying this to mental health, as long as the mean and the scores are known for any measurable characteristic you can then calculate the standard deviation. Any scored two SD or more away from the mean denotes an abnormality. All you need to be able to do is objectively measure mental health.
• The DASS (depression, anxiety and stress scale) uses a questionnaire to measure depression, anxiety and stress with a very high sore considered abnormal and in need of treatment

Question 13

Strengths of statistical infrequency as a definition of abnormality

Answer 13

Real world application:
- used in clinical practise, both as part of formal diagnosis and as a way to assess the severity of an individual symptoms
- for example a diagnosis of intellectual disability disorder requires an IQ off below 70- bottom 2%
- an example of statistical infrequency used in an assessment tool is the beck depression inventory (BDI)- a score of 30+ (top 5%) is widely interpreted as indicating severe depression
- this shows that the value of the statistical infrequency criterion is useful in diagnostic and assessment processes

gives a quantitative measure which is objective:
- there is a clear cut off point as to what is and is not abnormal
- this means that it is more likely to be reliable so that someone else administering the test would get the same results and draw the same conclusion
- this is important as defining abnormality can be a subjective process
- this is a strength as if it gives an objective measure then it means access to treatment and funding may be easier as it is seen as scientific and rigorous

not affected by culture or contacts like deviation from social norms:
- because no judgments are made by the clinician which depends on how society views behaviour
- the explanation solely relies on statistical information about how frequent the behaviour is
- strength as it reduces any stigma associated with mental illness being wrong or unacceptable, rather it is just less frequent than other behavioural traits

Question 14

Weaknesses of statistical infrequency as a definition of abnormality

Answer 14

Unusual characteristics can be positive:
- for example IQ scores of higher than 130 are just as unusual as those lower than 70
- wouldn’t think of superintelligence as undesirable or needing treatment- it is infrequent so classed as abnormal but doesn’t need treatment
Wouldn’t think of someone with very low BDI score as abnormal
- these examples show that being unusual or at one end of a psychological spectrum does not necessarily make someone abnormal
- weakness of means it can’t be used to have a diagnosis- can form part of an assessment and diagnostic procedure but is never sufficient as the sole basis for defining abnormality

Problems of labellling:
- not everyone benefits from a label
- some may be fulfilled or happy while still being statistically infrequent- such as someone with a low IQ who isn’t distressed or is coping with their lifestyle
- being labelled as abnormal may have negative consequences and may affect self esteem- there is a social stigma attached to such labels

Not all abnormal behaviours are infrequent:
- for example depression occurs in around 10% of the population at some point during their lives
- according to this definition, these people would not be abnormal because the behaviour is not within 3SD from the average- not statistically abnormal
- weakness as if seen as normal, people may not get diagnosed or help

Question 15

Describe deviation from ideal mental health as a definition of abnormality

Answer 15

• according to this definition we are abnormal if we do not meet the criteria for ideal mental health, thus any deviation from what is considered normal is classed as abnormal
• this definition proposes a set of characteristics of what is required to be normal- Jahoda (1958)- describe six characteristics that individuals should exhibit in order to be seen as normal- an absence of any of these characteristics indicates individuals as being abnormal
• there is some inevitable overlap between what we might school deviation from ideal mental health and what we might call failure to function adequately- for example if someone has an inability to keep a job, it could either be a failure to cope with the pressures of work or as deviation from the ideal of successfully working

Question 16

Describe the characteristics that are part of deviation from ideal mental health as a definition of abnormality

Answer 16

• positive attitude towards oneself- having self respect and a positive self concept
• self actualization- being motivated to fulfil your full potential- experiencing personal growth and development
• autonomy- being independent, self reliant and able to make personal decisions
• resisting stress- having effective coping strategies and being able to cope with everyday anxiety provoking situations
• accurate perception of reality- perceiving the world in a non distorted fashion, with an objective and realistic view of the world
• 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.

Question 17

Strengths of deviation from ideal mental health as a definition of abnormality

Answer 17

More positive approach than other definitions:
- its focus is on the positives rather than the negatives of behaviour in terms of looking at what behaviour is ideal rather than what behaviour is abnormal
- this is a strength as it could lead to mental health being seen as less of a stigma in society- in turn may lead to people being more willing to seek help from others

Practical applications:
- ask there are six specific criteria that are deemed to make up ideal mental health, it means that if someone is deviating from one of these characteristics we know exactly what that individual needs support on in order to feel better
- supports the definition ask this allows professionals to create personal goals to work towards for patients in order to facilitate self growth and thus remove the individual of their abnormality
- COUNTER- in practise these practical applications may not be possible. This is because many of the six criteria are based on subjective concepts and are therefore difficult to measure in the way that we can measure physical health. In order to diagnose mental health we use more subjective methods such as interviews, which may not be internally valid as they rely on memory and interpretation. This is an issue because it means that it is likely to be difficult to actually decide if somebody is deviating from the criteria and therefore difficult to easily treat individuals.

Comprehensive definition:
- Jahoda’s concept of ideal mental health includes a range of criteria for distinguishing mental health from mental disorder
- in fact it covers most of the reasons why we might seek or be referred for help with mental health- this in turn means that an individual’s mental health can be discussed meaningfully with a range of professionals who might take different theoretical views- for example in medically trained psychiatrist might focus on symptoms whereas a humanistic counsellor might be more interested in self actualization
- this means that ideal mental health provides a checklist against which we can assess ourselves and discuss psychological issues with a range of professionals

Question 18

Weaknesses of deviation from ideal mental health as a definition of abnormality

Answer 18

May be Culture bound:
- the ideal mental health criterion have elements that are not equally applicable across a range of cultures
- some of Jahodas criteria are firmly located in the context of the US and Europe generally
- in particular the concept of self actualization would probably be dismissed as self indulgent in much of the world- in non western cultures the ideal person puts others before themselves and works for the common good
- even within Europe there is quite a bit of variation in the value placed on personal independence for example it is high in Germany but low in Italy
- furthermore what defines success in our working, social and love lives is very different in different cultures
- means it is difficult to apply the concept of ideal mental health from one culture to another

Extremely high standards:
- very few of us attain all of Jahodas criteria for mental health, and probably none of us achieve all of them at the same time or keep them up for very long
- it’s can be disheartening to see an impossible set of standards to live up to
- it cannot be a true measure of abnormality because no one achieves ideal mental health- most people struggle with at least one of the criteria for ideal mental health- for example most people have negative views about themselves from time to time
- COUNTER- on the other hand having such a comprehensive set of criteria for mental health to work towards might be of practical value to someone wanting to understand and improve their mental health

Question 19

What are phobias

Answer 19

Characterised by excessive fear and anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus. The person with the phobia may go to great lengths to avoid the object of the fair and experience great distress if it is encountered. In order to be diagnosed with a phobia under the DSM5, the irrational fears and reactions must result in interference with social and work life.

Question 20

Categories of phobias

Answer 20

• specific- Fabia of an object, such as an animal or body part, or a situation such as flying or having an injection
• social anxiety- phobia of a social situation such as public speaking or using a public toilet or transport
• agoraphobia- phobia of being outside or in a public place

Question 21

What are three categories of characteristics of phobias

Answer 21

Behavioural, emotional, cognitive

Question 22

Describe behavioural characteristics of phobias

Answer 22

Panic:
- a person with a phobia may panic in response to the presence of the phobic stimulus. Panic may involve a range of behaviours including crying, screaming, or running away
- children may act slightly differently, for example by freezing, clinging or having a tantrum

Avoidance:
- unless the person is making a conscious effort to face their fear they tend to go two a lot of effort to prevent coming into contact with the phobic stimulus. This can make it hard to go about daily life.
- for example, someone with a fear of public toilets may have to limit the time they spend outside the home in relation to how long they can last without a toilet- this in turn can interfere with work, education and a social life

Endurance:
- the alternative behavioural response to avoidance is endurance
- this occurs when the person chooses to remain in the presence of the phobic stimulus- for example a person with a fear of spiders- arachnophobia- might choose to remain in a room with a spider on the ceiling and keep a wary eye on it rather than leaving

Question 23

Describe emotional characteristics of phobias

Answer 23

Anxiety:
- phobias are classed as anxiety disorders
- by definition fan they involve an emotional response of anxiety, an unpleasant state of high arousal
- this prevents a person relaxing and makes it’s very difficult to experience any positive emotion
- anxiety can be long term

Fear:
- although in everyday speech we might use terms anxiety and fear interchangeably they do have distinct meanings- fear is the immediate and extremely unpleasant response we experience when we encounter or think about a phobic stimulus- it is usually more intense but experienced for shorter periods than anxiety

Emotional response is unreasonable:
- the anxiety or fear is much greater than is normal and is disproportionate to any threat posed

Question 24

Cognitive characteristics of phobias

Answer 24

The cognitive element is concerned with the ways in which people process information- people with phobias process information about phobic stimuli differently from other objects or situations.

Selective attention to the phobic stimulus:
- if a person can see the phobic stimulus it is hard to look away from it
- keeping our attention on something really dangerous is a good thing as it gives us the best chance of reacting quickly to a threat, but this is less useful when the fear is irrational- may find it hard to concentrate on other things

Irrational beliefs:
- a person with a phobia may hold unfounded thoughts in relation to phobic stimuli- they can’t easily be explained and don’t have any basis in reality
- maybe less able to listen to us experts for example someone with a fair of having a heart attack may not listen to their doctor telling them their heart is normal
- disproportionate associations between stimuli, symptoms, or past history- for example a fear of a panic attack happening again after it’s happening once

Cognitive distortions:
- the perceptions of a person with a phobia may be inaccurate and unrealistic- for example an ophidiophobic may see snakes as alien and aggressive looking

Question 25

What is the key assumption of the behavioural approach to phobias

Answer 25

That’s all of our behaviour, including phobias, is learnt

Question 26

Describe the two process model to explaining phobias

Answer 26

• Proposed by Mowrer
• suggests that phobias are learnt/ initiated through classical conditioning and then they are maintained by operant conditioning. Thus we learn our behaviour from our environment and then our experiences within our environment also served to reinforce our phobia.

Question 27

Describe classical conditioning in terms of the behavioural approach to explaining phobias

Answer 27

• involves learning to associate something that three initially have No Fear of (neutral stimulus) with something that’s already naturally leads to a fear response (unconditioned stimulus)
• the natural response to an unconditioned stimulus is an unconditioned response- fear. If the unconditioned stimulus is paired with a neutral stimulus then you learn to react to the neutral stimulus in the same way you react to the unconditioned stimulus
• the neutral stimulus then becomes a conditioned stimulus leading to a conditioned response- fear
• this fear can then be generalised to similar objects

Question 28

Describe operant conditioning in terms of the behavioural approach to explaining phobias

Answer 28

• explains how phobias can be maintained once they have been learned via classical conditioning as classical conditioning does not explain how the phobia is maintained after initiation
• suggests that the consequences of our actions can lead to the behaviour being reinforced and carried out again
• negative reinforcement- refers to an action that stop something unpleasant occurring which then makes it more likely to carry out the behaviour again- stopping the negative consequences (fear) is rewarding- such as avoiding anywhere where you could see spiders- reinforced by avoiding these situations as the individual will continue to carry out this behaviour as long as it removes the fear
• positive reinforcement- giving a reward
• Mower- suggested that whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that we would have experienced if we had remained there- this reduction in fear reinforces the avoidance behaviour and so the phobia is maintained

Question 29

Strengths of the behavioural approach to explaining phobias

Answer 29

Research evidence- Watson and Rayner:
- research evidence to support acquisition of phobias via classical conditioning
- baby Albert study
- used a white rat as a neutral stimulus, paired it with from a loud noise from an iron bar- unconditioned stimulus
- noise caused fear response- crying- unconditioned response
- learn to associate the white rat with the fear response- rats became conditioned stimulus, crying with just the white rat became the conditioned response
- became generalised to all similar objects such as rabbits, cotton wool
- supports the behavioural approach as it demonstrates that phobias can be learnt through associating an unconditioned stimulus with a neutral stimulus
- HOWEVER- issue with the controls nature of this experiment. In this experiment, the rats and loud noise were paired together a number of times, in a controlled environment with no other distractions- extraneous variables. Issue as it lacks ecological validity. In real life, we are likely to only experience two stimuli together only once rather than a number of times. Therefore an association between an unconditioned stimulus and a neutral stimulus may not be made during a one off pairing meaning classical conditioning may not explain at the initiation of phobias

Research evidence: DiNardo et al, Munjack, De Jongh et al:
- DiNardo found that over 60% of people with a fear of dogs (cynophobia) could relate their fear to a particular frightening experience
- Munkack found that half of the people with a driving phobia could relate their phobia to a frightening or traumatic experience in a car, such as an accident
- this supports classical conditioning as an explanation of how phobias are developed because it suggests that an association has occured leading to the development of a feared stimulus
- De Jongh- found that 73% of people with a fear of dental treatment had experienced a traumatic experience, mostly involving dentistry. This can be compared to a control group of people with low dental anxiety where only 21% had experienced a traumatic event. Confirms that the association between stimulus (dentist) and an unconditioned response (pain) does lead to the development of a phobia
- HOWEVER, it is not there straight forward as if we look at the control group in DiNardos study, there was a similar number of participants who had a negative experience with a dog but did not have the phobia. Therefore this questions whether phobias are truly a result of classical conditioning, as it seems to be that there are individual differences that affect whether or not a experience leads to the development of a phobia
- not all phobias appear following a bad experience. Some common phobias such as snake phobias occur in populations where very few people have had any experience of snakes let alone traumatic experiences. Father, not all frightening experiences leads to phobias. This means that the association between phobias an frightening experiences is not as strong as we would expect if behavioural theories provided a complete explanation.

Practical application:
- it can be applied to exposure therapies such as systematic desensitisation
- the distinctive element of the two process model is the idea that phobias are maintained by avoidance of the phobic stimulus
- this is important in explaining why people with phobias benefits from being exposed to the phobic stimulus
- once the avoidance behaviour is prevented it ceases to be reinforced by the experience of anxiety reduction and avoidance therefore declines
- in behavioural terms the phobia is the avoidance behaviour so when this avoidance is prevented the phobia is cured
- this is a strength as it shows the value of the two process approach because it’s identifies a means of treating phobias- the fact that it has been shown to treat them suggests they are learned

Question 30

Weaknesses of the behavioural approach to explaining phobias

Answer 30

Ignores role evolution plays:
- ignores other factors which affects phobic behaviours
- Bounton (2007)- evolution plays an important role- the two factor theory doesn’t mention this
- for example we often acquire phobias of a source danger in evolutionary past- such as snakes or of the dark
- we developed these in an adaptive way overtime
- Seligman- calls this biological preparedness- an innate predisposition to acquire certain fears
- explains why we have less phobias of more recent things such as cars and guns- we are not yet biologically adapted to learn fear responses to these things
- issue as shows there is more to acquiring phobias than simple conditioning

Simplistic explanation:
- ignores cognitive factors that could play a role in the development of phobias
- our thought process and how we think about the feared stimulus is also important and in particular how we focus our attention
- for example people with a fear tend to focus on the elements of the stimuli that provoke anxiety such as the teeth of a dog rather than its other features
- behavioural explanations, including the two process model, are geared towards explaining behaviour- in the case of phobias the key behaviour is avoidance of the phobic stimulus. However, we know that phobias are not simply avoidance responses- they also have a significant cognitive component- doesn’t offer an adequate explanation for phobic cognition’s
- this is a problem of the behavioural approach because it may not be as simple as learning a phobia through association. A phobia is a complex disorder and one of the symptoms is an irrational fear, suggesting thought processes are involved

Question 31

Describe systematic desensitisation

Answer 31

• a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning
• over a period of time the conditioned fear response two the conditioned stimulus changes to a learned response of relaxation
• this is called counterconditioning as it is impossible to feel both fear and relaxation at the same time- they are opposing feelings- so the aim is that relaxation prevents the fear- this is called reciprocal inhibition
• three processes- the anxiety hierarchy, relaxation, exposure

Question 32

Describe the anxiety hieracrchy as part of systematic desensitization

Answer 32

• put together by a client with a phobia and a therapist
• list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening- for example seeing a picture of a small spider at to the bottom to holding a tarantula at the top

Question 33

Describe relaxation as part of systematic desensitization

Answer 33

• the therapist teaches the clients to relax as deeply as possible- reciprocal inhibition as it is impossible to be afraid and relaxed at the same time so one emotion prevents the other
• the relaxation may involve breathing exercises or, alternatively, the clients might learn mental imagery techniques.
• clients can be taught to imagine themselves in relaxing situations or they may learn meditation
• alternatively relaxation can using drugs such as Valium

Question 34

Describe exposure as part of systematic desensitization

Answer 34

• finally the client is exposed to the phobic stimulus while in a relaxed state
• this takes place over several sessions, starting at the bottom of the anxioty hierarchy
• when is the clients can stay relaxed in the presence of the lower levels of the phobic stimulus they move up the hierarchy
• treatment is successful when the clients can stay relaxed in situations high on the anxiety hierarchy
• exposure can be done in two ways- In Vitro- the client imagines exposure to the phobia stimulus, or in vivo- the client is actually exposed to the phobic stimulus

Question 35

What are the strengths of systematic desensitisation as a method of treating phobias?

Answer 35

Effectiveness:
- Gilroy et al- foloowed up 42 people who had SD for spider phobia in 3 45 minute sessions
- at both 3 and 33 months, SD group were less fearful than control group who were treated with relaxation without exposure
- Wechsler et al- concluded SD if effective for specific, social and agoraphobia
- SD likely to be helpful for people with phobias, 33 months- long lasting effects

Appropriateness:
- more ethical than drugs as these can be addictive and can limit our self control
- doesn’t require high communication skills- can help people wth learning disabilities- people may struggle with cognitive therapie that require complex rational thought, may feels confused and distressed by traumatic experience of flooding
- good accessibility- can help people with learning disabilities with phobias

Developing technology- virtual reality:
- can use VR to avoid dangerous situations e.g. heights, cost effective as psychologist and client don’t need to leave consulting room
- BUT- wechsler- VR may be less effective than real exposure as lacks realism

Question 36

What are the weaknesses of systematic desensitisation as a method of treating phobias?

Answer 36

Symptom substitution:
- when phobia is removed by SD , the anxiety may still be present and instead manifests itself in other phobias
- likely to be as SD treats symptoms not underlying cause
- Gilroy- didn’t test whether any other phobias had arised instead of spider phobia
- may get rid of phobia but not anxiety behind it- ignores cognitive thought

Not suitable for all phobias:
- Ohman et al suggests SD may not be as effective in treating phobias that have an underlying evolutionary survival component e.g. vear of drak, heights or dangerous animals than in treating phobias aquired as result of personal experience
- questions appropriateness of SD as it may not always be effective

Question 37

Describe flooding as a way of treating phobias

Answer 37

• based on same principles as SD- views phobias as being learnt through association and can therefore be unlearnt
• also works on principle of reciprocal inhibition- can’t feel 2 opposing emotions at same time- relaxation dominates fear over course of therapy
• rather than gradually exposing to phobic stimuli using hierarchy, flooding involves immediate exposure to very frightening situation
• sessions typically longer than SD, one that lasts a few hours may be enough to cure phobia
• stops phobic responses very quickly- without option of avoidance behaviour, client quickly learns phobic stimulus is harmless
• extinction (classical conditioning)- learnt reponse extinguished when conditioned stimulus is encountered without unconditioned stimulus- CS no longer produces CR
• may achieve relaxation due ti exhaustion from own fear response

Question 38

Describe ethical safeguards when using flooding as treatment of phobias

Answer 38

• not unethical but unpleasant experience so important that clients give fully informed consent to traumatic procedure and are fully prepared before session
• client normally given choice of SD or flooding

Question 39

What are the strengths of flooding as a method of treating phobias?

Answer 39

Effectiveness:
- can be used to treat wide range of phobias
- can be used in vivo (actual exposure) or in vitro (imagination) or via virtual reality
- VR may be suitable balance between actual and imagination as traumatic
- Rothbaum et al- VR and standard phobia more effective for treating flying phobia than being on waiting list for treatment (control)
- at 6 month follow up, VR and standard seen to be equally effective
- 93% of PPs having received treatment had flown in that time
- quick and safe way to treat phobias

Cost effective:
- Ougrin- stated its highly effective and faster
- often only need 1 session
- means patients free of symptoms ASAP- makes treatment faster and therefore cheaper

Question 40

What are the weaknesses of flooding as a method of treating phobias?

Answer 40

Only likely to be effective for specific phobias:
- may not be effective for social phobias
- specific- able to identify particular object or situation as source of phobia
- social phobias are more complex- particular source of phobia cant be identified, may also have cognitive aspects such as unpleasant thoughts about a social situation
- therefore other treatments may be more effective for some phobias and CBT

Traumatic experience:
- confronting ones phobic stimulus in an extreme form provokes serious anxiety
- Schumacher et al- found PPs and therapists rated flooding as significantly more stressful than SD
- raises ethical issue for psychologists of knowingly causing stress to their clients- not serious issue if gain informed consent
- means attrition (drop out) rates are higher than SD
- time and money may be wasted preparing patients only to have them refuse to start or complete treatment

Symptom substitution:
- may only mask symptoms, not tackle underlying cause
- Persons- reported the case of a woman with phobia of death who was treated using flooding- fear of death declined but fear of being criticised got worse
- BUT, only evidence for this comes from case studies- may not be generalisable to all phobias

Question 41

What categories of depression and depressive disorders does the DSM-5 recognise

Answer 41

• major depressive dissorder- severe but often short term depression
• persistent depressive disorder- long term or recurring depression, including sustained major depression and what used to be called dysthymia
• disruptive mood dysregulation disorder- childhood temper tantrums
• premenstrual dysphoric disorder- disruption to mood prior to and/or during menstruation

Question 42

Behavioural characteristics of depression

Answer 42

Activity levels:
- typically peopke with depression have reduced levels of energy, making them lethargic
- this has a knock-on effect, with people tending to withdraw from work, education and social life
- in extreme cases this can be so severe that the person can’t get out of bed
- in some situations this can lead t the opposite effect- psychomotor agitation- agitated individuals struggle to relax and may end up pacing up and down a room

Disruption to sleep and eating behaviour:
- a person may experience reduced sleep (insomnia), particularly premature waking, or an increased need for sleep (hypersomnia)
- appetite and eating may increase or decrease, leading to weight gain or loss
- such behaviours disrupted by depression

Aggression and self harm:
- often irritable, and in some cases they can become verbally or physically aggressive
- can have serious knock on effects in various aspects of life- e.g. may display verbal aggression by quitting a jo or ending a relationship
- can also lead to physical aggression directed against the self- includes self harm- often in form of cutting or suicide effects

Question 43

Emotional characteristics of depression

Answer 43

Lowered mood:
- more than daily kind of experience of feeling lethargic and sad- often describe themselves as feeling worthless or empty

Anger:
- negative emotions not limited to sadness
- frequently experience anger, can be extreme
- can be directed at self or others- may lead to aggressive or self harming behaviours

Lowered self esteem:
- self esteem is the emotional experience of how much we like ourselves- can be extremely low- self loathing

Question 44

Cognitive characteristics of depression

Answer 44

Poor concentration:
- person may find themselves unable to stick to a task as they normally would, or may find it hard to make decisions they would normally find straightforward
- poor concentration and decision making are likely to interfere with a persons work

Attending to and dwelling on the negative:
- when experience a depressive episode people are inclined to pay more attention to negative aspects of a situation and ignore the positives
- may also have bias to recalling unhappy events rather than happy ones

Absolutist thinking:
- most situations are not all good or all bad, but when a person is depressed they tend to think in these terms
- black and white thinking- when a situation is unfortunate, they tend to see it as an absolute disaster

Question 45

2 cognitive models of depression

Answer 45

• Becks negative triad
• Elis’s ABC model

Question 46

Elements of Becks approach to explaining depression

Answer 46

• schemas
• cognitive errors/biases
• the negative triad

Question 47

Describe Becks negative triad- schemas

Answer 47

• Beck believes that people become depressed because the world is seen through negative schemas
• these schemas dominate thinking and are triggered whenever individuals are in situations that are similar to those in which the negative schemas were learned
• Beck perceived negative schemas as developing in adolescence and childhood, when authority figures, such as parents, place unreal demands on individuals and are highly critical of them
• these negative schemas then continue into adulthood, providing a negative framework to view life in a pessimistic fashion
• we use schemas to interpret the world, and if we have a negative schema about ourselves then we will interpret all information about ourselves in a negative way

Question 48

Describe Becks negative triad- cognitive errors/biases

Answer 48

• negative schemas lead to cognitive biases and are reinforced by cognitive biases
• whenever we are faced with a stressful or challenging situation people with negative schemas leaf to faulty logic and flawed interpretation of events
• catastrophising- the worst will always occur
• all or nothing thinking
• over generalisation
• selective abstraction - only seeing negatives of event/day
• global judgements- overall view about oneself based on 1 event

Question 49

Describe Becks negative triad- the negative triad

Answer 49

Negative schemas and cognitive biases maintain what Beck refers to as the cognitive triad- a person develops a dysfunctional view of themselves because of 3 types of thinking that occur automatically, regardless of the reality. This is a pessimistic and irrational view of three key elements in a persons belief system.

1) Negative view of self- where individuals see themselves as being helpless, worthless and inadequate- enhance any existing depressive feelings as they confirm the existing emotions if low self esteem

2) Negative view of the world- obstacles are perceived as not being able to be dealt with, can create the impression that there is no hope anywhere- e.g. ‘he world is a cold hard place’

3) Negative view of the future- where personal worthlessness is seen as blocking any improvements- enhances depression and reduces any hopefulness

Question 50

What did Ellis suggest about depression

Answer 50

• proposed good mental health is the result of rational thinking, defined as thinking in ways that allow people to be happy and free from pain
• poor mental health e.g. depression results from irrational thoughts- not as illogocal or unrealistic but as any thoughts that interfere with being happy and free from pain
• used the ABC model to explain how irrational thoughts affect our behaviour and mental state

Question 51

Describe Ellis’s ABC Model

Answer 51

• A- Activating event- refers to an event in the environment. Tese events are everyday obstacles and difficulties that everyone is forced to deal with when interacting with the world- negative events trigger irrational beliefs- e.g. failing a test
• B- Beliefs- Irrational beliefs- e.g. mustabatory thinking- may involve catastrophising, Utopianism- the belief that the world is always meant to be perfect
• C- consequences- the emotional response to the belief- a rational belief leads to healthy emotions, an irrational belief can lead to unhealthy emotions- e.g. fails test- irrational mustabatory thought- can trigger depression

Question 52

Describe mustabatory thinking as part of Ellis’s ABC model

Answer 52

• seen as the source of irrational thinking
• thinking that certain ideas or assumptions must be true in order for an individual to be happy
• e.g. I MUST do very well, or I am worthless- thus someone with these beliefs are probably going to feel worthless and depressed in relation to activating events

Question 53

Strengths of the cognitive approach to depression

Answer 53

Practical applications:
- Beck’s ideas are used in CBT in terms of the negative triad. It aims to identify automatic thoughts about the self, world and the future and then to challenge these thoughts.
- Cohen et al- concluded that assessing cognitive vulnerability allow psychologists to screen young people, identifying those most at risk of developing depression in the future and monitoring them
- Ellis’s ideas have been used in rational emotive behaviour therapy- REBT- whereby therapist works with the patient to identify unchallenged irrational thoughts that occur in relation to events- they should in turn lead to a more positive emotional states
- David et al- provided some evidence to support the idea that REBT can break change negative beliefs and relieve symptoms of depression- has real world value
- CBT has been shown to be effective- suggests that cognition’s are therefore involved in the development of depression if by changing them we can treat depression
HOWEVER, the relationship between thought process is and depression may not be this straight forward. Cuijpers et al found that CBT was most effective when combined with drugs combat such as SSRIs. This suggests that it is not as simple as negative thoughts causing depression, there must also be a biological element as well, otherwise CBT alone would be the most effective. This is a weakness as by not considering biological factors we may be missing important influences on depression which in turn may lead to ineffective treatments being used.

Research evidence:
- Becks cognitive model- cognitive vulnerability refers to ways of thinking that may predispose a person to becoming depressed, for example faulty information processing, negative self schema under cognitive tryouts. Back concluded that not only were these cognitive vulnerabilities more common in depressed people but they preceded the depression. This was confirmed in a more recent perspective study by Cohen et al- track the development of 473 adolescents, regularly measuring cognitive vulnerability- phone box showing cognitive vulnerability predicted later depression- it shows there is an association between cognitive vulnerability and depression
- there is also research evidence to support that irrational thinking is involved in depression. Lloyd and Lishman- gave participants with depression stimulus words in response to which they were required to recall pleasant or unpleasant experiences from their past. Found that participants with low level depression responded faster when recalling pleasant memories than those participants with deeper depression, with response times increasing with the severity of depression. Supports the idea that depressed people have automatic negative thinking, suggesting that this negative thinking may lead to depression.
HOWEVER, this research does not show that irrational thinking causes depression. Research that tests irrational thinking in those with depression does so after the individual has been diagnosed with depression, therefore it is difficult to distinguish as to whether the irrational thinking is a cause or consequence of depression. For example, one of the symptoms of depression is that the individual experiences feelings of worthlessness, and it is clear to see that this could lead to irrational thoughts. This is a limitation of the cognitive approach as it means we may be missing the cause of depression and we may need to turn to other approaches such as the psychodynamic and their explanation of anger turned into self hatred as a cause of depression.

Question 54

Weaknesses of the cognitive approach to depression

Answer 54

responsibility placed on patient:
- the patient is seen as responsible for their psychological disorder as it suggests that we do have control over our thoughts, which are seen to influence our emotions and behaviour
- this may lead one to overlook social factors, such as family problems or life events
- consequently, attention may be drawn away from the need to improve social conditions that may have a significant effect on the quality of their life
- this is therefore a weakness of the approach as it may make therapy less effective long term for some individuals
- The ABC model is controversial because it locates responsibility for depression purely with a depressed person. Critics say this is effectively blaming the depressed person, which would be unfair. HOWEVER, provided it is used appropriately and sensitively, the application of the ABC model in REBT does appear to make at least some depressed people achieve more resilience and feel better.

Partial explanation:
- depressed people often feel extreme anger, and some experience solutions and delusions- particular patterns of cognition, and therefore Becks suggestion of cognitive vulnerabilities is only a partial explanation

Reactive and endogenous depression:
- Ellis’s model only explains reactive depression and not endogenous depression
- reactive depression refers to depression triggers by life events- activating events- how we respond to negative life events also seems to be at least partly the result of our beliefs
- however, many cases of depression are not traceable to life events and it is not obvious what leads to the person to become depressed at a particular time- this type of depression is sometimes called and endogenous depression- the model is less useful for explaining this type
- this means that the model can only explain some cases of depression and is therefore only a partial explanation

Depression may be rational:
- beliefs and thoughts of depressed people can actually be a rational reflection of reality rather than irrational and maladaptive
- Alloy and Abrahamson- found that depressed people tended to be more accurate when rating the likelihood of a disaster than ‘normal’ controls- called this the ‘sadder but wiser’ effect
- therefore, other approaches may also need to be considered, such as the behavioural and the suggestion that children can learn a depressed mood via social learning theory, to fully understand a person’s mental illness as irrational thinking alone may not be a cause

Question 55

Name a treatment of depression

Answer 55

Cognitive behavioural therapy- CBT

Question 56

Cognitive treatments of depression- aim, briefly describe

Answer 56

• the most commonly used psychological treatment for depression and a range of other mental health issues
• begins with an assessment in which the client on the cognitive behaviour therapist worked together to clarify the clients problems
• they jointly identify goals for the therapy and put together a plan to achieve them
• one of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge
• the behaviour element then involves working to change negative and irrational thoughts and finally put more effective behaviours into place
• 2 types- Beck’s cognitive therapy (CBT), Ellis’s rational emotive behavioural therapy (REBT)

Question 57

Beck’s cognitive therapy- aim

Answer 57

• to challenge the irrational thoughts within the cognitive triads and replaced them with more realistic appraisals - to identify automatic sorts about the worlds, the self and the future- then to challenge these thoughts
• as behaviour is seen to be generated by thinking, the most logical way to challenge maladaptive behaviour is to change the irrational thinking underlying it

Question 58

Beck’s cognitive therapy- describe

Answer 58

Identifying irrational thoughts:
- the therapist works with the patient to help them identify irrational thinking and maladaptive thoughts
- the client is in coverage to record their automatic negative thoughts and thoughts of how they may challenge these
- these may include asking themselves what the evidence is for such negative thinking, if there are alternative explanations, how other people may respond to the same situation, how it affects one to think so negatively, what type of thinking errors are occurring

Behavioural element:
- part of the therapy aims to alter dysfunctional behaviours that are contributing to or maintaining the depression
- this is done by encouraging patients to identify activities they used to enjoy and work to overcome cognitive obstacles in carrying them out
- damn baby homework set- such as to record when they enjoyed an event, or when people were nice to them- this is sometimes referred to as the client as scientist- investigating the reality of their negative beliefs- this can be used as evidence to prove the irrationality of statements such as ‘no one likes me’
- may also be homework such as creating a small list of goals for the day, for example getting out of bed and brushing teeth- small achievements should help the depressed person develop a sense of personal effectiveness

Question 59

Ellis’s REBT- aim

Answer 59

• to change irrational beliefs into rational beliefs so that individuals react to events in healthy ways

Question 60

Ellis’s REBT- describe

Answer 60

• Extends the ABC model to ABCDE- D meaning dispute, E for effect
• central technique is to identify and dispute irrational thoughts

Mustabatory thinking:
- aims to tackle their mustabatory thoughts so that they are able to accept themselves, faults and all
- also means they need to accept others for what they say and that other people will not necessarily be fair or kind
- they also need to accept that life has its ups and downs
- changing the irrational beliefs means that the consequences (C) are more positive due to the change in beliefs (B)

Challenging irrational thoughts:
- ‘Dispute’- refers to having a ‘vigorous argument’ which challenges the irrational thinking with the aim of breaking the link between the activating event (A) and the consequence of negative feelings of depression (C)
- logical disputing- considering whether the negative thought logically follows from the facts
- pragmatic disputing- emphasise is the lack of usefulness of these beliefs
- empirical argument- involves disputing whether there is actual evidence to support the negative belief
- may identify cognitive errors such as utopianism and challenge this as an irrational belief

Question 61

Describe behavioural activation as a cognitive approach to treating depression

Answer 61

• as individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms
• aim is to work with the depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood, such as exercising or going out with friends- at the therapist aims to reinforce such activity

Question 62

Strengths of the cognitive approach to treating depression

Answer 62

Evidence for effectiveness:
- launch body of evidence supporting CBT’s effectiveness in treating depression
- March et al (2007)- compare the effectiveness of CBT with anti depressants and a combination of both in 327 depressed adolescents. Found 81% success rate after 36 weeks in either one alone, 86% when using a combination of the both- clinically significant difference.
- TADS team (2007)- found CBT had equal success to fluoxetine after 36 weeks. Suicides or events more common in patients receiving fluoxetine- 14.7%- than combination therapy- 8.4%- or CBT- 6.3%
- taken together combat these studies support the use of CBT as it helps people get over depressive episodes equally effectively as drugs, and with lower suicidal event rates- widely seen as the first choice of treatment in public healthcare systems such as the NHS- also cost effective as fairly brief (6-112 sessions)

Teaches client skills:
- for example patients are told how to challenge irrational thoughts on how to look for the evidence to support them
- this teaches the patient how to challenge their future irrational thoughts alone
- this is a strength as CBT is therefore likely to be a longer lasting treatment than others such as drugs because it teaches coping strategies for the future rather than just suppressing symptoms

Question 63

Weaknesses of the cognitive approach to treating depression

Answer 63

Not effective for everyone:
- Simon et al (1995)- suggested CBT is not suitable for people who have high levels of stress that reflect realistic stressors in the persons life, as the therapy cannot resolve these and therefore cannot help the depression
- it may therefore be important that the person suffering from depression is treated as an individual and their individual circumstances are taken into accounts before treatment is decided for the sufferer of depression

Assumes individual can change own though patterns:
- may not be suitable for those with learning disabilities- Sturmey (2005)- suggests that in general, any form of psychotherapy- at talking therapy- is not suitable for people with learning disabilities- includes CBT. The complex rational thinking involved in CBT makes it unsuitable for treating people who cannot access this.
- also may not be suitable for those with severe depression. All personalities are highly ingrained and take a lifetime to develop, therefore in the space of A cause of CBT we cannot expect to fully change someone’s thinking patterns. May be a problem in severe depression as there may not be motivation, acceptance and focus to engage in CBT.
- suggests CBT may only be appropriate for a specific range of people with depression, may not be appropriate for all sufferers of depression and it may be more appropriate to use medication alongside CBT
COUNTER:
- although the conventional wisdom has been that CBT is unsuitable for very depressed people and for clients with learning disabilities, there is now some more recent evidence that challenges this
- Lewis and Lewis (2016)- concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression
- Taylor et al (2017)- concluded that’s come up when used appropriately, CBT is effective for people with learning disabilities
- means CBT may be suitable for a wider range of people than was once thought

Relapse rates:
- high relapse rates
- although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last
- relatively few early studies of CBT for depression looked at long term effectiveness
- some more recent studies suggest that long term outcomes are not as good as had been assumed
- Ali et al- assessed depression in 439 clients every month for 12 months following a course of CBT. 42% relapsed into depression within six months of ending treatment, 53% relapsed within a year.
- means CBT may need to be repeated periodically

Client preference:
- not all clients want to tackle their depression by identifying and changing unhelpful patterns of thinking and behaviour
- some people just want their symptoms gone as quickly and easily as possible and prefer medication
- others, for example survivors of trauma, wish to explore the origins of their symptoms
- Yrondi et al- found that suppressed people rated CBT as their least preferred psychological therapy

Question 64

Describe family studies as a basis for the genetic biological explanation of OCD

Answer 64

• Lewis (1936)- observed 37% of his OCD patients had parents with OCD, 21% siblings
• suggests it can run in families, although only genetic vulnerability passed on as mot certain
• diathesis-stress model- certain genes leave some people more likely to develop a mental disorder but it is not certain- some environmental stress is required to trigger the condition

Question 65

Describe twin studies as a basis for the genetic biological explanation of OCD

Answer 65

• Miguel et al (2005)- used monozygotic (identical) twins and dizygotic (non-identical) twins
• if OCD is genetic, we would expect a higher concordance rate in MZ compared to DZ- meaning if one MZ twin had OCD we would also expect the other to develop it
• found a 53-87% chance of one MZ twin developing OCD of one already had it compared to a 24-47% chance in DZ twins
• suggests there is a genetic basis for OCD, however never 100% so also environmental factors

Question 66

Describe specific genes as a basis for the genetic biological explanation of OCD

Answer 66

• more recent research has used DNA profiling to compare genetic material of those suffering with OCD to those not suffering from OCD
• this research has found that it is unlikely that one specific gene causes OCD, but instead more likely that it is a combination of genes that determine an individual’s level of vulnerability to the condition- polygenic- Taylor (2003)- analysed findings of previous studies and found evidence that up to 230 genes may be involved in OCD- includes those associated with the action of dopamine as well as serotonin
• COMT gene- involved in the production of the neurotransmitter dopamine- Tuckel et al (2013)- found one form of the COMPT gene to be more common in ocd patients than people without the disorder- all genes come in different alleles- this variation produced lower activity of the COMPT gene and higher levels of dopamine
• SERT gene- a.k.a 5-HTT gene- affects the transmission of serotonin, leading to lower levels in the brain. Bengel et al (1999)- compared 75 Caucasian patients with OCD to 397 ethnically matched individuals who did not have OCD. Found that the patients with OCD were more likely (47%) two Curry 2 copies of the long allele of the gene compared to controls (32%)

Question 67

What is a developing explanation in the genetic biological approach to explaining OCD

Answer 67

• epigenetic’s- although we are born with our DNA that does not change, the way our sales and genes are activated- switched on- is what can lead to changes in mental illness
• please outsides- epigenetic- factors can affect the way the gene expresses itself, for example it may release more or less protein and this can affect our behaviour and physical traits
• known as the diathesis-stress explanation

Question 68

describe the role of neurotransmitters as a basis for the neural explanation of the genetic explanation for OCD

Answer 68

• your genetic makeup can affect the levels of neurotransmitters in the brain
• neuro transmitters pass information from 1 neuron to another- at two key nearer transmitters which appeared to play a role in OCD are serotonin and dopamine
• serotonin- believed to help regulate mood- if a person has low levels of serotonin then normal transmission of moods relevant information does not take place and a person may experience low moods and other mental processes may also be affected. At least some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain. Serotonin can affect how anxious we feel
• dopamine- linked to experiencing motivation, rewards and compulsions. When a pleasurable experience occurs, increased dopamine leads to feelings of pleasure. Overtime, with OCD the anxiety associated with obsessive thinking is stopped only by the pleasure of completing the compulsion.

Question 69

describe the role of brain structures/systems as a basis for the neural explanation of the genetic explanation for OCD

Answer 69

Decision making systems:
- some cases of OCD, in particular hoarding disorder, seemed to be associated with impaired decision-making
- this in turn may be associated with abnormal functioning of the lateral frontal lobes of the brain
- the frontal lobes are the front part of the brain that are responsible for logical thinking and making decisions
- there is also evidence to suggest that an area called the left parahippocampal gyrus associated with processing unpleasant emotions functions abnormally in OCD

Brain areas:
- when area of the brain that has been implicated in OCD is the orbitofrontal cortex (OFC)- sends signals to the thalamus about things that are worrying. If a part of the basal ganglia (Caudate nucleus) is damaged it fails to stop minor worry signals and the thalamus is alerted. When this circuit is activated these impulses are brought to your attention and cause you to perform behaviour that addresses the impulse.
- PET scans have shown that when a sufferer of OCD has active symptoms, there is heightened activity in the OFC

Question 70

Strengths of the biological approach to explaining OCD

Answer 70

GENETIC-
Research evidence:
- Nestadt et al (2010)- reviews previous twin studies- found 68% of identical twins shared OCD compared to 31% of non identical twins
- suggests genetic influence on OCD
- Marini and Stebnicki (2012)- found that a person with a family member diagnosed with OCD is around four times as likely to develop it as someone without
- HOWEVER, no study finds a 100% concordance rates and even if it did we cannot factor out the role of environment. OCD may appear to run in families because MZ twins are more likely to be treated in a similar way than DZ twins as they look the same. Therefore even when there is high concordance rates it does not tell us that this is due to biological factors.

Practical Application:
- if we know certain genes are involved in OCD, for example SERT, we can scan for these in babies who are deemed at risk due to family history and provides individuals with support early on
- strength as if this works, it suggests there is a biological cause to OCD

Animal Studies:
- evidence from animal studies showing that particular genes are associated with repetitive behaviours in other species, for example mice- Ahmari (2016)
- HOWEVER, although mice and humans share most genes, the human minds on brain are much more complex, and it may not be possible to generalise from animal repetitive behaviour to human OCD

NEURAL-
Research evidence:
- Saxena and Rach- reviewed studies of OCD that used PET, fMRI and MRI neuroimaging techniques and found consistent evidence of an association between the OFC and OC symptoms.
- HOWEVER, research into the basal ganglia also gives conflicting findings. Neuroimaging studies have so far failed to find basal ganglia impairments in all sufferers of OCD and some people who do have impairments in the basal ganglia do not show symptoms of OCD- Ring and Serra-Mestres (2002)
- Nestadt- found link between OCD symptoms forming parts of conditions that are known to be biological in origin, such as the degenerative brain disorder Parkinson’s disease which causes muscle tremors and paralysis. If a biological disorder produces OCD symptoms, then we may assume the biological processes underlie OCD.

Practical Application:
- can be used to try and treat people who suffer with OCD
- for example, if low levels of serotonin are thought to play a role in OCD we can give people SSRIs which aim to increase the amount of serotonin available in the signups to continue to stimulate the post synaptic neuron

Question 71

Weaknesses of the biological approach to explaining OCD

Answer 71

GENETIC-
Research is correlational:
- we only test for a genetic link after OCD is developed
- it might be that there are higher rates within a family because it is a learnt behaviour and is observed in others family members- role models- and then imitated by the children- social learning theory
- problem as it means we cannot be sure that biological factors are actually causing OCD, and we may be overlooking important influencing factors such as the psychodynamic explanation of fixation in the anal stage during childhood development

Lack of precision:
- there are too many different candidate genes- several genes are involved- each with genetic variation- each one alone only increases the risk of OCD by a fraction
- weakness as genetic explanations have little predictive value

Environmental risk factors:
- there are also environmental risk factors- OCD doesn’t seem to be entirely genetic in origin and it seems that environmental risk factors can also trigger or increase the risk of developing OCD- Cromer et al- found that over half of the OCD clients in the sample had experienced a traumatic event in their past- also more common in those with one or more traumas
- means that genetic vulnerability only provides a partial explanation

NEURAL-
Research is correlational:
- when looking at the levels of neurotransmitters it may be that these levels change as a result of having OCD rather than causing OCD, or both could be influenced by a third factor

Lack of precision:
- it is not clear exactly what neural mechanisms are involved.
- studies of decision-making have shown got these neural systems are the same systems that function abnormally In OCD - Cavedini et al (2002)
- some research has identified brain systems sometimes involved but none always play a role in OCD- can’t claim to understand neural mechanisms in OCD fully

No unique neural system:
- the serotonin-OCD link may not be unique to OCD
- many people who have OCD also experience clinical depression- co-morbidity
- this depression probably involves, though is not necessarily caused by, disruption to the action of serotonin
- leaves a logical problem when it comes to serotonin as a possible basis for OCD- put simply be that serotonin activity is disrupted in many people with OCD because they are depressed as well- means serotonin may not be relevant to OCD symptoms

BOTH-
Reductionist:
- OCD is a very complex disorder comprising of both cognitive obsessions and behavioural compulsions, as well as the emotional state of anxiety
- to explain all of this by simply referring to a gene or a neurotransmitter is unlikely to be reflective of the unique experiences that we encounter as humans that affect our development
- this is a problem of its means the biological approach is not taking into consideration other causes such as the two process model
- classical conditioning could explain an aversion to dirt for example if associated with anxiety and negative reinforcement in planes fly the compulsions are maintained as they relieve anxiety
- therefore by being reductionist we are not looking at individuals holistically in order to understand the cause of OCD

Question 72

Briefly outline the biological approach to treating OCD

Answer 72

• drug therapy aims to increase or decrease levels of neurotransmitters in the brain or to increase or decrease their activity
• low levels of serotonin are associated with OCD- therefore drugs to treat OCD work in various ways to increase the level of serotonin in the brain
• this increase in serotonin causes the OFC to function at more normal levels
• e.g. SSRIs

Question 73

SSRI’s- how they work

Answer 73

Selective serotonin reuptake inhibitor:
- the presynaptic cell sends information via a synapse
- by sending this information, neurotransmitters are released into the gap- serotonin is one of these
- the receptors on the surface of the postsynaptic cell recognises these neurotransmitters and passes on the message
- 90% of these near transmitters are released from the receiving receptors and then taken up again by the sending cell- reuptake
- upon taking SSRI face stop the reuptake of serotonin, meaning it stays in the synapse gap longer than it normally would
- this can lead to repeated stimulation of the receptors on the post synaptic nerve ending and higher levels of serotonin

Question 74

SSRIs- dosage, most common one

Answer 74

• fluoxotine (prozac) in adults- usually don’t take affect on symptoms until three to four months after taking them daily
• typical daily dose of fluoxetine is 20mg although this may be increased if it is not benefiting the person
• the drug is available as capsules or liquid

Question 75

What may SSRIs be combined with, describe this

Answer 75

• drugs are often used alongside CBT to treat OCD
• the drugs reduce a persons emotional symptoms, such as feeling anxious or depressed- this means that people with OCD can engage more effectively with the CBT
• in practise some people respond best to CBT alone whilst others benefit more when additionally using drugs like fluoxetine
• occasionally other drugs are prescribed alongside SSRIs

Question 76

What can happen if an SSRI is not effective after three to four months, give details of this

Answer 76

• the dose can be increased e.g. up to 60 mg a day for fluoxetine, or it can be combined with other drugs
• sometimes different anti depressants are tried- people respond very differently to different drugs and alternatives work well for some people and not at all for others
• Tricyclics- older type of anti depressants- e.g. clomipramine- apps on various systems including the serotonin system where it has the same effect as SSRIs- clomipramine how’s most severe side effects than SSRIs- generally kept in reserve for people who don’t respond to SSRIs
• SNRIs- serotonin-noradrenaline reuptake inhibitors- more recently been used to treat OCD- different class of antidepressant drugs, second line of defence for people who don’t respond to SSRIs- increase levels of serotonin and noradrenaline

Question 77

Strengths of the biological approach to treating OCD

Answer 77

Evidence of effectiveness:
- clear evidence to show SSRIs verges symptom severity and improve the quality of life for people with OCD
- Soomro et al (2009)- reviewed 17 studies that compared SSRIs to placebos in treatment of OCD
- all 17 studies showed significantly better outcomes in SSRIs than placebo conditions
- typically symptoms reduced for around 70% of those taking SSRIs
- for remaining 30%, most can be helped by either alternative drugs or combinations of drugs and psychological therapies
- means thoughts drugs appear to be helpful for most people with OCD
COUNTER- there is some evidence to suggest that even if drug treatments are helpful for most people they may not be the most effective treatments available. Skapinakis et al (2016)- courage out a systematic review of outcome studies and concluded that both cognitive and behavioural therapies were more effective than SSRIs in the treatment of OCD - means drugs may not be optimum treatment for OCD.

Cost effective and non-disruptive:
- in general they are cheap compared to psychological treatments because many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy- therefore using drugs to treat is get value for public health systems like the NH S and represents a good use of limited funds
- as compared to psychological therapies, SSRIs also non disruptive to peoples lives- if you wish you can simply take drugs until your symptoms decline- quite different from psychological therapy which involves time spent attending therapy sessions
- means that drugs are popular with many people with OCD and their doctors

Quick and easy:
- all the user has to do is remember to take the required dosage each day- requires little physical time or cognitive effort- to somebody who is already suffering from anxiety, having to find the time to attend psychological meetings and be on time for these without compulsions getting in the way may lead to further anxiety
- this is a strength as drugs are therefore more desirable than psychological therapy such as CBT and the patient does not have to go onto a waiting list to await for a therapist to be able to see them

Question 78

Weaknesses of the biological approach to treating OCD

Answer 78

High relapse rates:
- drugs may only treat the symptoms rather than the cause of OCD
- can be seen in the relapse rates following discontinuing medication
- Simpson et al (2004)- suggests 45% of patients treated with medication relapsed within 12 weeks, compared to 12% to received a psychological therapy
- suggests truck use may only be temporary solution- not long term

Side effects:
- a small minority will get no benefit from SSRIs
- they may also cause serious side effects such as- indigestion, blurred vision, loss of sex drive
- these side effects are usually temporary, however they can be quite distressing for people and for a minority they are long lasting
- for those taking the tricyclic clomipramine, side effects are more common and can be more serious- for example more than 1/10 people experience erection problems and weight gain, 1/100 become aggressive and experience disruption to blood pressure and heart rhythm
- means that some people have a reduced quality of life as a result of taking drugs and may stop taking them altogether, meaning the drugs cease to be effective

Biased evidence:
- there is always some controversy over the evidence for the effectiveness of drugs
- some psychologists believe that the evidence for drug effectiveness is biassed because researchers are sponsored by drug companies and may selectively published positive outcomes for the drugs their sponsors are selling- Goldacre (2013)
- HOWEVER, there is a lack of independent studies of drug effectiveness and also research on therapies may be biased- the best evidence available is supportive of the usefulness of drugs for OCD

Question 79

Describe the DSM 5 categories of OCD

Answer 79

• OCD- characterised by either obsessions and or compulsions- most have both
• trichotillomania- compulsive hair pulling
• holding disorder- the compulsive gathering of possessions and the inability to part with anything, regardless of its value
• excoriation disorder- compulsive skin picking

Question 80

Describe the behavioural characteristics of OCD

Answer 80

Behavioural component is compulsive behaviour- ability to perform everyday tasks and conduct meaningful social relationships can be severely hindered

Compulsions are repetitive:
- typically people with OCD feel compelled to repeat a behaviour

Compulsions reduce anxiety:
- around 10% of people with OCD show compulsive behaviour alone- they have no obsessions, just a general sense of irrational anxiety
- however, for the vast majority, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions such as hand washing as a response to an obsessive fear of germs

Avoidance:
- avoidance may happen in an attempt to reduce anxiety by keeping away from situations that make trigger it- manage OCD by avoiding situations that trigger anxiety however this meat leads to avoiding ordinary situations and can interfere with leading a regular life

Question 81

Emotional characteristics of OCD

Answer 81

Anxiety and distress:
- regarded as a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions
- obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming
- the urge to repeat a behaviour hyphenate compulsion- creates anxiety

Accompanying depression:
- ocd is often accompanied by deppression, so anxiety can be accompanied by low mood and a lot of enjoyment in activities
- compulsive behaviour tends to bring some relief from anxiety but this is temporary

Guilt and disgust:
- as well as anxiety under pressure, OCD sometimes involves other negative emotions such as irrational guilt, for example over minor moral issues, or discust, which may be directed against something external like dirt or at the self

Question 82

Describe cognitive characteristics of OCD

Answer 82

Obsessive thoughts:
- for around 90% of people with O CD the major cognitive feature of their condition is obsessive thoughts that reccur over and over again
- these vary considerably from person to person but are always unpleasant

Cognitive coping strategies:
- obsessions are the major cognitive aspect, but people also respond by adopting cognitive coping strategies to deal with the obsessions such as praying if religious and tormented by obsessive guilt
- this may help too manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks

Insight into excessive anxiety:
- aware that their obsessions and compulsions are not rational- necessary for a diagnosis
- if someone really believed that obsessive thoughts were based on reality that would be a symptom of a different mental disorder
- however in spite of this insight, people with OCD experienced catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified
- also tend to be hypervigilant- maintain constant awareness and keep attention focused on potential hazards