Psychopathology Flashcards
How might people define ‘Being Normal’
Acting in a way that society defines as acceptable and natural (socially acceptable manner)
Fits in with with society’s expectations
Seen as being desirable
How might people define ‘Abnormality’
Goes gassing societal norms and expectations
Quite rare/less frequently seen
Generally considered as undesirable
Statistical Infrequency
One way to define anything as ‘normal’ or ‘abnormal’ is to consider and count how often we see it
Any behaviour that is relatively com on is seen as normal
Any behaviour that is rare is seen as abnormal
E.G: - schizophrenia has a 1% prevalence rate
- bipolar disorder has 2.8% prevalence rate
- bpd has a 0.1-2% prevalence rate
- 5% of people have an IQ either under 70 and more than 130
These are all rare and therefore seen as abnormal
Statistical Infrequency Strength
One strength of this definition is that is has real world application
For example, it is used in clinical practise to help assess and diagnose individuals
Fern example, in order to be diagnosed with an intellectual disability you need to be in the bottom 2% of IQ scores (an IQ below 70)
Or to be considered to have severe depression you would need to have a score in the top 5% on the Beck Depression Inventory (a score 30 or above)
This is a strength because ‘abnormal’ diagnosis can benefit individuals because they can then access relevant support services or therapies
Statical Infrequency Limitations
One limitation is that a rare characteristic can also be a positive and seen as desirable
For example, according to this definition, people with a high IQ (which is seen as desirable) are labelled as ‘abnormal’
This is a limitation because ‘abnormal’ implies undesirability and a high IQ is actually desirable
Another limitation is that mental illness is not that rare, but mental illness is considered as abnormal. 1 in 4 people will experience a mental health problem of some kind each year in England, which isn’t rare
Deviation from Social Norms
Most of us notice when people behave in a way that deviates from social norms
- i.e. behave in a way that goes against what a group considers to be socially acceptable ways of acting
These social norms are specific to the culture we live in (both across time and culture)
Any characteristic that deviates from the social norm in which the person lives is seen as abnormal
Behaviours that would deviate from British 21st century social norms and therefore considered abnormal according to this definition
Social norms (explicit laws):
Don’t murder
Don’t steal ext
Implicit (implied):
Showing respect
Behaving appropriately for the occasion (e.g. don’t wear swim wear to college)
Mental Disorder Considered as Deviation
One example of a behaviour that would be considered abnormal under this definition is antisocial personality disorder (psychopathy)
Personality traits of this include:
- manipulativeness
- deceitfulness
- callousness
- hostility
Deviation from Social Norms Strengths
This definition takes into account whether the behaviour shown is desirable or not
For example, people with high IQs do not end up as being labelled abnormal according to this definition as they are not breaking social norms with their intelligence
This is a strength because is it a better definition than statical infrequency because bit takes into account the desirability of the behaviour.
This increases the validity of the definition as it makes it more accurate
Deviation from Social Norms Limitations
Social norms, values, attitudes and morals change over time and consequently so do ideas about what is normal and abnormal
For example, ideas about homosexuality gave changed over the years. In the past in Britain, it was illegal to be gay. People who were gay were considered to deviate from social norms and therefore as abnormal and suffering from mental illness. It wasn’t until 1973 that
homosexuality was removed as a mental illness. However now it is considered very normal.
This is a limitation as it means we never have a definite understanding of abnormality. It makes this definition lack reliability and consistency.
However it can also be seen as strength because it shows that the definitions of abnormality reflect current knowledge and understanding of human behaviour
Deviation from Social Norms Strength 2
It is the case that many people who are clinically abnormal do behave in a way that breaks social norms.
For example, people who have antisocial personality disorder will steal from or hurt other people - 2 behaviours that break social norms
People with anxiety also sometimes display behaviours that would be considered abnormal, just not to the same extreme. For example they may:
- avoid eye contact
- doesn’t make conversation
- not speaking up when expected
This is a strength because it suggests the definition has validity
- i.e. it actually measures what it claims to measure (abnormality)
Deviation from Social Norms Limitation 2
This definition can lead to people who are non-conformists and/or eccentric to being labelled ‘psychologically’ abnormal
Fo example people with multitalented extreme piercings or those involved in subcultures like goths do in always differ from implicit social norms at Tim’s, but aren’t actually psychologically abnormal
This is a limitation because it shows the definition cannot always accurately identify abnormality
Failure to Function Adequately
Any characteristic or behaviour that prevents a person from coping and managing with day to day demands is seen as abnormal
Some day to day demands that this might be impacted by a failure to function adequately are:
Holding down a job
Getting an education
Basic self-care
Holding down romantic and platonic relationship
Going shopping
Getting a bus
Measuring How Well an Individual Functions
The Global Assessment of Functioning Scale (GAF) is a method of measuring how well individuals function in everyday life based upon the following criteria:
1 unpredictability
2 maladaptive behaviour
3 personal distress
4 irrationality
5 observer discomfort
6 occupational dysfunction
The more of these criteria met, the less likely you are to be able to function adequately
Based off the DSM-5 criteria for depression, why might someone with depression be considered abnormal under the failure to function definition?
Someone with depression will find it hard to go to work or college due to fatigue and/or due to their reduced or diminished concentration. They will also find it hard to maintain high levels of self-care (e.g. not eating properly). They will find it difficult to hold down relationships due to feelings of worthlessness. So people with depression are likely to score high on the GAF. Their behaviour is maladaptive, it causes personal distress and it results in occupational disfunction too
Failure to Failure Adequately Strengths
The definition as validity - it is the case that the majority of people with a diagnosed mental health illness do fail to function adequately e.g. depression, schizophrenia, agoraphobia
It can be a good indication that someone might need help if they suddenly stop being able to function adequately
It does acknowledge how the person themselves feel. The GAF considers personal distress when measuring the extent to which someone is failing to function
Failure to Function Adequately Limitations
Some abnormal behaviours can actually help a person to function e.g. OCD rituals will reduce anxiety in the short term and help you cope
Not all people with a mental illness fail to function adequately e.g. some addicts can hold won a job, have a normal family, have a nice house and so on. They do appear to functioning adequately, however they are still struggling greatly
At some points in our lives, most of us will fail to function adequately e.g. at a time of bereavement
- it can become difficult to judge when someone’s grief moves from being normal grief levels to abnormal grief levels
Deviation from Ideal Mental Health
Any individual who does not meet the criteria of being ‘normal’ is seen as abnormal
Ideal mental health may look like:
- being happy
- having self-confidence
- good self esteem
- willing to give new things a go
- having good relationships with others
- having good coping strategies
Ideal Mental Health Criteria
The psychologist Maria Jahoda was one of the early pioneers to focus more on mental health than mental illness
In the 1950s, she said that ideal mental health consists of having:
- no symptoms or distress
- a positive attitude towards oneself
- the opportunity to self-actualise
- the ability to resist stress
- personal autonomy
- an accurate perception of reality
- the ability to adapt to one’s environment
Deviation from Ideal Mental Health Strength
A strength is that this definition allows for an individual who is struggling to have targeted intervention is their behaviour is not seen as ‘normal’
For example, a lack of self-esteem could be addressed to help their behaviour becoming normal. This could involve visiting a counsellor who will help them providing unconditional positive regard, warmth and empathy
This is a strength because it allows for clear goals to be set focused upon achieving ideal mental health, and, in Johoda’s opinion, achieve normality
Deviation from Ideal Mental Health Limitation
The criteria outlined by Jahoda makes ideal mental health (normality) practically impossible to achieve
For example, at times, we all struggle to adapt to change (e.g. bereavement our when we are faced with stress or with our self esteem)
This is at limitation because it means that to be ‘mentally healthy’ (i.e. normal) os very hard to achieve, so we are likely to all be diagnosed as ‘abnormal’; according to this definition
Deviation from Ideal Mental Health Limitation 2
The definition can be seen as culture-bound to western, individualistic cultures
(Individualistic ‘what is in it for me’. Non-western collectivist ‘how well my actions impact on others)
For example, the criteria of autonomy makes the collectivist cultures, where the greater good hand helping/relying on others is encouraged, seem abnormal. As most western cultures are individualistic, the criteria outlined by Jahoda seem a reasonable fit, but non-western cultures cannot relate yo the criteria she outlines
This is a limitation because it mans that this definition lacks population validity i.e. it is not true for all people
DSM-5 Categories of Phobias
Phobias are an excessive fear and anxiety triggered by an object or a situation
Separate from specific phobias, the DSM-5 recognised the categories social phobia
- phobia of a social situation such as public speaking
They also recognise agoraphobia
- phobia of being outside
Characteristics of Phobias
Regardless of the type of phobia, they are characterised by the same behavioural, environmental and cognitive responses
- i.e. how we act, feel and think in the presence of the phobic stimulus
Behavioural Characteristics of Phobias
When we are faced with something that may threaten our safety, we respond by behaving in a particular way
Generally this is high levels of anxiety or trying to escape (fight or flight)
There are three that we need to know about:
- panic
- avoidance
- endurance
Behavioural Characteristics of Phobias - Avoidance
Unless someone is making a conscious effort to face their phobia, people will typically go to extreme lengths to avoid and prevent coming in to contact with the phobic stimulus
This type of avoidance behaviour can make everyday life very difficult
E.g. someone with a fear of public toilets may limit the amounts of time they spend outside of the home
Behavioural Characteristics of Phobias - Endurance
In direct opposing to avoidance is endurance
This is where an individual exposes themselves to the phobic stimulus but is in a constant stat of high naxie ty while doing so
Someone with arachnophobia may do this by picking up a spider in their house
Someone might do this if their stimulus is unavoidable. For example, a person with agoraphobia may need to leave the house to get food shopping to continue to live
Behavioural Characteristics of Phobias - Panic
Someone with a phobia may panic in the presence of the phobic stimulus
This could involve a range of behaviours. This might involve:
- shaking
- crying
- heavy breathing
Children may respond differently and may freeze, have a tantrum or cling to their caregiver
Emotional Characteristics of Phobias
These characteristics are related to a person’s feelings or mood
There are three that we need to know about:
- anxiety
- fear
- unreasonable emotional response
Emotional Characteristics of Phobias - Anxiety
DSM-5 classifies phobias as anxiety disorders
- therefore by definition they involve an notional response of anxiety
This prevents a person from relaxing because they are in a very unpleasant state of high arousal which makes it very difficult for the individual to experience any positive emotions
This can be long term
Emotional Characteristics of Phobias - Fear
We may use ‘anxiety’ and ‘fear’ interchangeably, but we need to know their distinct definitions and meaning in terms of phobias
Fear is immediate and extremely unpleasant, experienced when we encounter or even thinjk about the phobic stimulus
- (anxiety is more feeling uneasy or distressed about a situation or object)
It is generally more intense but for shorter periods than anxiety
We experience fear when our fight or flight response is activated
Emotional Characteristics of Phobias - Unreasonable Emotional Response
The degree of anxiety and fear experienced by omens with a phobia is significantly greater than the average person and can be seen as an unreasonable emotional response to the phobic stimuli
Cognitive Characteristics of Phobias
The cognitive aspect of phobias is concerned with how individuals process information
People with a phobia generally process information about the phobic stimulus differently from other objects or situations
The three we need to know about are:
- selective attention to the stimulus
- irrational beliefs
- cognitive distortions
Cognitive Characteristics of Phobias - Selective Attention to the Stimulus
If an individual can see the phobia stimulus, it can be very difficult to look away from it
Keeping an eye on something that could potentially be dangerous is a good thing as it give us the best chance of reacting quickly, should we need to
This is not so useful when he fear is irrational,m as it is with the phobia
Obsessively checking for the phobic stimulus may put you in danger
- e.g. you may be distracted while looking and getting hit by a moving vehicle
Cognitive Characteristics of Phobias - Irrational Beliefs
People with phobias typically hold unfounded irrational beliefs about the phobic stimulus
- i.e. having very little basis in reality but persist in the absence of evidence for them
Form example, people with social phobias may think that if they blush, others will perceive them as weak
This irrational belief increases the pressure on the individual to perform well in social situations, and so increases the anxiety and so on
Cognitive Characteristics of Phobias - Cognitive Distortions
People with phobias generally have distorted perceptions that maybe inaccurate or unrealistic
They may consider the phobic stimulus to be ugly or disgusting, compared to the opinion of most of he population
The Two-Process Model
The two-process model explanation of phobias is based on they behaviourist approach and therefore it suggests that phobias are learnt
The behavioural explanation of phobias isn particularly concerned with the three behavioural characteristics of phobias (panic, avoidance, endurance)
Mowrer (1960) proposed the two-process model as a way of explaining phobias
This states that phobias are acquired by classical conditioning and are maintained by operant conditioning
The Two-Process Model - Classical Conditioning
The basic idea here is that we first acquire the phobia through the process of classical conditioning
We have an unpleasant and scary experience with an object or situation and then we associate the object or situation with fear
This is the first process in the two-process model
The Two-Process Model - Operant Conditioning
A response (including a phobia) that is acquired by classical conditioning will generally be extinguished, unless it is maintained by operant conditioning
- i.e. deteriorate over time
This might happen if the idea of the phobia is continued to be reinforced reinforcement (specifically negative reinforcement) and punishment
In the case of negative reinforcement, an individual avoids a situation that is unpleasant, which results in a desirable consequence so the behaviour is not repeated
Mowrer also said that when we avoid the phobic stimulus, we escape the anxiety and fear that we would have experienced, which reinforces the avoidance behaviour and maintains the phobia
The Two-Process Model Strength
One strength is that there is evidence to support the two-process model with studies that show a link between bad experiences and phobias
For example, in addition to the Little Albert Study, Jongh et al (2006) found that 73% of people with a fear of dental treatment has experienced a traumatic experience (mainly involving dental treatment) compared to only 21% of a control group with low fear of dental treatment
This is a strength because it adds validity to the theory that phobias develop due to classical conditioning, due to a fearful experience being paired with a stimuli
The Two-Process Model Limitation (linked to a strength)
However, the Jongh et al (2006) dentist study shows that the evidence isn’t fully conclusive
It shows that 27% of people who have a phobia of the dentists did not ever have a traumatic experience that triggered the phobia. How are their phobias then explained?
There was also 21% of people in the control group of low fear of the dentist had a traumatic experience at the dentist, but didnb’t have a phobia. Why is this?
Finally, many people in the UK have a phobia of snakes yet there is a low likelihood of exposure ton these for a traumatic experience to occur. These phobias may be better explained through evolution and the theory of biological preparedness
The Two-Process Model Limitation 2
One limitation is that the two-process model focuses mainly on the behavioural elements such as avoidance.
Other characteristics are ignored, such as the emotional characteristics (anxiety, fear and unreasonable emotional response) and the cognitive characteristics (selective attention to the stimulus, irrational beliefs and cognitive distortions)
This is a limitation because this is not then a complete explanation of the characteristics of phobias
The Two-Process Model Strength 2
One strength is that the two-process model has practical applications with exposure therapies for phobias
For example, exposure therapies such as systematic desensitisation and flooding work by preventing the avoidance response. This will help because it means the phobia is not being negatively reinforced. This means that people can face their phobia and it can be extinguished
This is a strength of the two-process model identifies a means of treating phobias. This also adds to the validity of the model because if it was ‘wrong’ then any therapies based on it wouldn’t work
Systematic Desensitisation
At the heart of SD is counterconditioning
This refers to learning a new stimulus-response association that runs counter to the original association
So in the context of phobias, the client will move from responding to a stimulus with fear too responding to it with relaxation
First Process of SD
Anxiety Hierarchy:
They therapist and client work together to create an anxiety hierarchy in which we arrange situations related to the stimulus in order from the least frightening (at the bottom) to the most frightening (at the top)
Second Process of SD
Relaxation and reciprocal inhibition:
- deep breathing exercises
- muscle relaxation exercises
- mental imagery techniques
- use of drugs such as Valium
It is important that the client can relax because it is physically impossible to be both anxious and relaxed at the same time as they are opposite physical states
- known as reciprocal inhibition
Third Process of SD
Exposure:
- work up the hierarchy, starting with the least feared situation
- you are exposed to it and employ your relaxation
- once you can be exposed to it and stay calm and more relaxed, move up to the next level
- the goal is to reach the top, the most feared situation, and stay relaxed
In Vivo - work up the hierarchy with actual exposure at each level (so, for example, you are in a room with a real dog on a lead)
In Vitro
SD Strength - Supporting Research
One strength of SD is that there is supporting research showing that is it an effective therapy
For example:
- McGrath (1990) reported that approx. 75% of people with phobias responded successfully to SD
- Capafons (1998) found that 20 clients with a fear of flying who received a 12-25 week programme of SD showed less psychological signs of fear and reported lower fear levels whilst in a flight simulator compared to a control group of 21 clients with a fear of flying two received no treatment
- Gilroy et al (2003) followed up on 42 people who had three 45 minute SD sessions for a spider phobia compared to a control group who were treated with relaxation without exposure. At both 3 months and 33 months, the SD group were less fearful than the control group
- a recent review by Wechsler et al (2019) concluded that SD is effective for specific phobias, social phobias and agoraphobia
This is a strength because it adds validity to SD as a therapy - it shows that it can help people over come phobias, suggesting it is a valuable therapeutic technique
SD Limitation
One limitation of SD is that it isn’t an appropriate treatment for all phobias
For example , Seligman (1970) argued that SD would not be effective for treating phobias that have a biological evolutionary explanation (e.g. snakes, heights) rather than a conditioning explanation, because these phobias are not learnt and therefore cannot be ‘unlearnt’
This is a limitation because it means that not everyone with a phobia will benefit from SD and it might waste time on a therapy that would never work for them because it wasn’t learnt
SD Strength - a more accessible therapy
One strength of SD is that as a therapy it is readily accessible to most people, including people who might usually struggle to use psychological therapy for some reason
For example:
- people with learning disabilities who have phobias who may struggle with other forms of therapy with their phobia (e.g. cognitive therapy which requires a high level of cognitive processing to examine thoughts and reasons behind the phobia) can work with SD
This is a strength because it means that a number of people who who otherwise might not be able to treat their phobia can be helped to over come it
SD Strength - Cost-effective and safe options
One strength of SD is that it can be seen as being both a cost-effective and safe option fo treating phobias
For example, in vitro SD could be sued where exposure would be dangerous and expensive, e.g if a client has a phobia of sharks where it could potentially be dangerous and very expensive to take them swimming with sharks in the sea with a shark cage
This is a strength because it shows that clients don’t actually have to face their fear in order to benefit from SD, showing that it is a very flexible therapy that can save money
However, there is some evidence to suggest in vitro SD is less effective than in vivo exposure. This could be because you are never actually put in a situation where you actually have to physically face their phobia, and therefore you are never putting into practise your strategies that you have in case you ever do
SD Strength - Ethics
One strength of SD is that it can be seen as a more ethical treatment of phobias compared to other exposure therapies, such as flooding
From example, the anxiety hierarchy is drawn up with the client and the therapist together and each step up the hierarchy is conducted at the pace of the client
This is a strength because it means that the client is more likely to stick withy the therapy and ultimately be counter-conditioned
However, there is still inevitably still going to be stress for the client given the nature of SD, as it exposes them to their phobic stimuli
Flooding
Flooding also involves exposing people with a phobia to their phobic stimulus, but without a gradual build-up in an anxiety hierarchy
Instead, flooding involves immediate exposure to a very frightening situation
So a person with arachnophobia receipt flooding treatment might have a large spider crawl over them for an extended period
Flooding sessions are typically longer than SD sessions, one session lasting two to three hours
Sometimes only one session is needed to cure a phobia
How Does Flooding Work?
Flooding stops phobic responses very quickly
This may be because, without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless
In classical conditioning terms, this process is called extinction
- a learned response is extinguished when the conditioned stimulus (e.g. dogs) is encountered without the unconditioned stimulus (e.g. being bitten)
- the result isn that the conditioned stimulus no longer produces the conditioned response (fear)
Ethical Safeguards
Flooding is not unethical per se but it is an unpleasant experience, so it is important that clients give fully informed consent to this traumatic procedure and they are fully prepare before the flooding session
A client would normally be given the choice of systematic desensitisation or flooding
Flooding Strength
One strength of flooding is that it is cost-effective
For example, as you are immediately faced with the most extreme level of your phobic stimulus, you may very quickly over come this fear. You may only need a few, or even just one, session
This is a strength because it means money does not need to be spent on extremes therapy, meaning it can be offered to more people, and is an option for people who cannot afford extended therapy, in places where healthcare is not free
Flooding Limitation
One limitation of flooding is potential issues due to being put in an extremely uncomfortable situation
For example, if you have arachnophobia, flooding may involve having a large spider crawl across you for an extended period of time, which is obviously going to cause extremely high levels of anxiety
This is a limitation, as you need to fully ensure you have informed consent, which people may not agree to, and participants are much less likely to drop out of therapy
Categories of Depression
Major Depressive Disorder:
- sever but often short-term
Persistent Depressive Disorder:
- long-term, recurring and sustained
Disrupted Mood Dysregualation Disorder:
A childhood condition of extreme irritability, anger and frequent, intense temper outbursts
Premenstural Dysphoric Disorder:
Disruption to mood prior to and/or during mensuration
Behavioural Characteristics of Depression
Our behaviour changes when we experience an episode of depression
These changes will be observable to others
The three we need to know about are:
- activity levels
- disruption to sleep and eating behaviour
- aggression and self-harm
Behavioural Characteristics of Depression - Activity Levels
People with depression will often have reduced energy levels (lethargic)
- in severe cases, the person cannot get out of bed
This will have a knock on effects on other parts of their lives, such as aspects like:
- relationships
- school/college/work
- self-care
This would lead to them being considered abnormal under the definition of ‘failure to function’
However, in some cases, it has the opposite effects and people develop psychomotor agitation
This is when an individual demonstrates movements that serve no purpose
Examples include:
- pacing around a classroom
- wringing hands
- tapping fingers and feet
- fidgeting
- starting and stopping tasks abruptly
- talking very quickly
- moving objects around for no reason
- taking off clothes then putting them back on
Behavioural Characteristics of Depression - Disruption to Sleep and Eating Behaviour
Depression disrupts sleeping and eating behaviour
You might over or under sleep as a result of depression:
- the term for reduced sleep is insomnia
- the term for increased sleep is hypersomnia
- your appetite and weight might increase or decrease
- a change of weight by 5% (loss or gain) is seeing as significant
Behavioural Characteristics of Depression - Aggression and Self-Harm
Depression is a mood disorder and people with depression are often irritable
This can, in some instances, lead to the individual becoming verbally or physicality aggressive, both to others (e.g. having arguments with a partner resulting in an ending of a relationship) and to themselves (e.g. in the form of self-harm and/or suicide attempts)
Emotional Characteristics of Depression
These characteristics are related to a person’s feelings or mood
There are three that few need to know about:
- lowered mood
- anger
- lowered self-esteem
Emotional Characteristics of Depression - Lowered Mood
Everyone feels low, down or sad sometimes
- these are normal emotions
Fortunately for the vast majority of us, a low mood will pass after a couple of days a week
However, in depression the lowered mood will persist for a longer period of time
People with depression report more than just ‘feeling sad’
- they report feeling empty and hopeless and a loss of enjoyment in life
Emotional Characteristics of Depression - Anger
People with depression experience more negative emotions than positive
- this included anger as well as sadness
This emotion of anger can result in the behaviours of aggression and self-harm
Emotional Characteristics of Depression - Lowered Self-Esteem
Self-esteem refers to the emotional experiences of how much we like ourselves
People with depression tend to have reduced self-esteem
This can be very extreme, with people with depression describing a strong sense of self-loathing
Cognitive Characteristics of Depression
The cognitive aspect of depression is concerned with how individuals process information
People with depression generally process information about the world quite differently from the ‘normal’ ways that people with depression think
The three cognitive characteristics we need to know about are:
- poor concentration
- attending to and dwelling on the negative
- absolutist thinking
Cognitive Characteristics of Depression - Poor Concentration
Depression is associated with poor concentration
Having poor concentration might affect someone’s life in different ways, such as:
- difficulty following a conversation
- zoning out
- failing school/college work
- finding basic tasks challenging
Cognitive Characteristics of Depression - Attending to & Dwelling on the Negative
People with depression are inclined to pay more attention to the negative aspects of a situation and ignore the positives
For example, someone without depression who has just received a promotion may think:
- feel happy and proud
- ‘I’m a success’
- see it as more of a challenge in which they can succeed
Whereas people with depression may think:
- dwell on how it will be more work and effort
- see it ad more of a threat
- feel pressurised
They may also have a more ‘glass half empty’ point of view on life and situations
Cognitive Characteristics of Depression - Absolutist Thinking
Absolutist, or ‘all-or-nothing’, thinking is one of many negative thought processes that is common in depression
When thinking in all-or-nothing terms, you split your views unto extremes
- everything, from your view of yourself to your life experiences, is divided into black-or-white terms
For people with depression, this often means only seeing the downside and believing that they’re a complete failure in life or that they will never succeed or that no one will ever love them
Cognitive Explanations of Depression Introduction
Beck and Ellis’s models of depression are both based on the cognitive approach and focus on the negative pattern of thinking seen in depression
Beck’s Negative Triad
Aaron Beck (1967) suggested that some people are more vulnerable to depression because they have cognitive vulnerability which leads them to interpret their experiences in a negative way that makes them more susceptible to depression
He suggested three parts to this:
1 - faulty information processing
2 - negative self-schema
3 - the negative triad
Faulty Information Processing
Part 1
Think back to the information processing approach in the cognitive approach approach - if something goes ‘wrong’ with the processing step, then the output is also faulty
1 - encoding of sensory information
2 - information manipulation (mental processes)
3 - output (e.g. behaviour, emotion)
Negative Self-Schema
step 2
Beck believed that depression prone individuals develop a negative self-schema:
- a schema is a pocket of information we create to quickly process information about the world
- a negative self-schema is where individuals have a negative thought tendancy about themselves - they automatically think negatively about themselves (and potentially the world and environment around them)
- these can potentially come from low levels of involvement from parents
These negative self-schemas are more likely to lead to people becoming depressed
- in Evans et al (2005), it was found that people with negative self-schemas were significantly more likely to experience depression and was not an early symptom, but instead a long lasting vulnerability
Beck’s Negative Triad
step 3
Three types of negative thinking that occurs automatically
The Self - “I’m ugly/worthless/a failure”
The World - “No one loves me”
The Future - “I’m hopeless because things will always be this way”
Beck’s Negative Triad Strengths
It has good supporting evidence
- for example, Grazioli and Terry (2000) assessed 65 women on their cognitive vulnerability and found that women they deemed to vulnerable were more likely to suffer with postnatal depression
- this was supported by Cohen et al (2019) who carried out a prospective study on 473 adolescents in which cognitive vulnerability was regularly measured measured and they found that cognitive vulnerability predicted later depression
This showed that cognitions can be seen before depression depression emerges, which supports Beck’s theory
It has practical applications
- we can screen people for risk of depression and monitor them
- if people do develop depression then they can be treated with CBT that aims to alter these faulty cognitions
This is a positive shows it can be translated into a from of treatment
Beck’s Negative Triad Limitations
It does not explain all aspects of depression
- patients will often experience multiple emotions with depression, from anger to sadness
- they may get hallucinations or bizarre beliefs
- Beck’s theory does not take into account those extreme emotions
Therefore, Beck’s theory cannot explain all cases of depression, only focusing on one aspect of it
Ellis’s ABC Model
Albert Ellis (1962) proposed that goof mental health is the result of rational thinking
- i.e. ways of thinking that allow us to be happy and free from psychological pain
Depression is therefore the result of irrational thoughts
He used the ABC model to explain how irrational thoughts affect behaviour and emotional state
Ellis’s ABC Model - A
A = activating events
Irrational thoughts are triggered by external events
We get depresses when we experience negative events which can trigger irrational beliefs
For example, you get a bad test score and therefore you believe you will fail in life
Ellis’s ABC Model - B
B = beliefs
Irrational beliefs can include:
‘Musturbation’ - i must succeed and achieve perfection
‘I-can’t-stand-it-itis’ - it is a major disaster whenever something does not go smoothly
‘Uptopianism’ - life is always meant to be fair
Ellis’s ABC Model - C
C = consequences
Activating events trigger irrational beliefs and these result in emotional and behavioural consequences
For example, if you are bitten by a dog, then you will be scared of every dog biting you
Ellis’s ABC Model Strengths
It has had practical applications
- it has led to the development of a from of cognitive therapy known as REBT (rational emotive behaviour therapy)
- REBT works by extending the ABC model to include D and E
- disputing irrational beliefs leading to positive effects (reduced depression)
- Ellis claimed a 90% success rate in REBT over 27 sessions
This is a positive as it shows it can be translated into an effective form of treatment
Ellis’s ABC Model Limitations
It only explains reactive and not endogenous depression
- reactive depression is triggered by life events (or activating events)
- however, many cases of depression have a biological, or endogenous, cause, e.g. genetics or abnormal neurotransmitters activity
- Ellis’s ABC model is less useful for explaining endogenous depression
This means his model is only a partial model
Beck’s and Ellis’s Explanations Ethical Issues
Both models are are minimalist and ignore the effects of genes
- because they are cognitive theories, it emphasises the effect that thought can have on an individual, but his does not explain genetic links to depression, such as concordant MZ twin studies
Cognitive Behaviour Therapy
Cognitive Behaviour Therapy (CBT) is the most commonly used psychological therapy used for depression
This is split into two elements:
Cognitive Element
- CBT begins with an assessment in which the therapist and client work together to identify negative thoughts that are contributing to their depression
Behavioural Element
- CBT then involves working to change negative and irrational thoughts and put more effective behaviours into place
CBT - Dysfunctional Thought Diary
As ‘homework’, clients are asked to keep a record of the events leading up to any unpleasant emotions experienced
They should record the automatic ‘negative’ thoughts associated with these events and rate how much they believe these thoughts on a scale of 1-100%
Next, clients are required to write a rational response to the automatic thoughts and rate their belief in the rational response, again as a percentage
Finally, clients should re-rate their beliefs in the automatic thoughts
Cognitive Restructuring
Once the client has revealed more about their thought patterns to the therapist, they can then work together on identifying and changing negative thought patterns
This is done collaboratively and is known as ‘therapy during therapy’
A client may feel distressed about something they have overheard, assuming another person (person X) was talking about them
During CBT, the client is taught to challenge dysfunctional automatic thoughts
- for example, by asking themselves:
- where’s the evidence that person X was talking about me?
- what is the worst that can happen if person X was?
By challenging these dysfunctional thoughts, and replacing them with more constructive ones, clients are able to try out new ways of behaving
Pleasant Activity Planning
This technique involved asking the client to plan for each day (say, over the period of a week)
One pleasant activity they will engage in
It could be something that gives a sense of accomplishment (e.g. going to a new class in gym) or something that will involve a break from a normal routine (e.g. eating lunch away from the desk)
It is thought that engaging in these pleasant activities will induce more positive emotions, and that focusing on new things will detract from negative thinking patterns
This is an example of a behavioural activation technique
- helping clients change their behaviour
The technique involved asking clients to keep a record of the experience, noting how theft felt and what the specific circumstances were
If it didn’t go as planned, the client is encouraged to explore why and what might be done to change it
By taking action that moves towards a positive solution and goal, the patient moves further away from negative thinking and maladaptive behaviour
Ellis’s REBT Therapy - D and E
D = disputing irrational beliefs
- refers to the ability to dispute and disprove irrational beliefs
E = effective new beliefs
- being able to form a new effective belief that aids performance
Ellis’s REBT Therapy
REBT focuses on disputing the irrational beliefs that arise from the activating event
Ways irrational thoughts can be disputed by the therapist include:
Logical Disputing - using logical and rational reasoning to challenge irrational beliefs - “Does thinking you must get A grades in every piece of work as otherwise you are a failure make sense?”
Empirical Disputing - works by asking the individual to talk about the evidence they have to back up their irrational beliefs - “What is the evidence that no one loves you?”
Pragmatic Disputing - works by getting the individual to realise that this thought pattern is not going to help them - “How is the belief that you are worthless getting to help you?”
REBT Therapy Sessions Disputing
The effects of disputing is to replacing these irrational and unhealthy beliefs with healthy, rational ones
This then has an effect of the client feeling better and becoming self-accepting
- this is hard if they have had these irrational thoughts for a long time
However, disputing can involve ‘vigorous argument’ between client and therapist
Ellis therefore said that the therapist must be skilled in providing unconditional positive regard (warmth, empathy and respect) during the dispute aspect of REBT to help convince the client of their worthy as a human being and to help facilitate a change in their beliefs
CBT Strength - Studies involving Antidepressants
Jarrett et al (1999) found that CBT was as effective as some antidepressant drugs when treating 108 patients with severe depression over a 10 week trial
March et al (2007) compared CBT to antidepressant drugs and to a combination of CBT and drugs when treating 327 adolescents with depression
After 36 weeks the following %s of each group showed improvement:
- CBT alone = 81%
- Antidepressants alone = 81%
- CBT and Antidepressants = 86%
This shows that CBT can be as affective as antidepressants and even more so when they are both combined, adding validity to the therapy
CBT Limitation - Not as Effective
Holmes (2002) claims that the single largest study into effective treatments for depression (carried out by the National Institute for Mental Health) showed that CBT was less effective than antidepressant drugs and other psychological therapies
In addition, Holmes argues that the evidence for the effectiveness of CBT come mainly from trails of highly selected patients with only depression and no additional symptoms
This argues that CBT is actually not nth at effective and would not be effective with patients with conditions than depression alone
This means that CBT would not be suitable for a larger range of people with depression
CBT Strength and Limitation - Therapy Length
CBT is intended to be a relatively brief therapy - usually between 6-12 sessions
This may not be enough for a lot of people with more complex depression
You may have coping mechanisms from these therapies, but they can ben hard to reinforce using, especially with such little time with therapist support
However, the short time frame means that people are less likely to drop out and just stick it out, completing an entire therapy
CBT Limitation - Motivation
In som cases, depression can be so severe that clients cannot motivate themselves to enage3 in the demands of CBT
- e.g. keeping a thought diary
If you cannot engage in the demands it will not be effective and won’t help the patient
- CBT will be unable to reach its full potential
CBT Strength - Challenging Criticism
More recent research had challenged the view that CBT is not suitable for people with severe depression
For example, Lewis & Lewis (3016) conducted a review and concluded CBT is as effective as antidepressants and other behavioural therapies for people withy severe depression
This is a trend that as it is challenging the criticisms of CBT, reinforcing its validity as a therapy
CBT Limitation - not always accessible
CBT requires a high level of rational thought and so may not be suitable for some groups
- e.g. children and people with learning disabilities
This is a limitation as it is not accessible to everyone
People with depression also may not have the energy required for a high level of rational thought, meaning it may not help them as much as therapies that’s require less straining thought
CBT Limitation - Long-Term Effectiveness
Few early studies into the effectiveness of CBT considered its long-term effectiveness and more recent research suggests long-term benefits of CBT are not as good as first assumed
Ali et al (2017) assessed depression in 439 clients every month for 12 months following a course of CBT
42% of clients relapsed into depression within 6 months and 53% relapsed within 12 months
This is a limitation as it is not that effective in the long term
It could be argued that if you relapse, there is no point in having the therapy in the first place
To solve this, CBT could be paired with longe term counselling or having a few more sessions after 6 months to reinforce the initial CBT and help prevent relapse
This would help improve the long-term effectiveness of CBT
CBT Limitation - The Therapists
Therapist competence (e.g. ability to structure sessions, foster good therapeutic relationships) appeared to explain a significant amount of variation in CBT outcomes
Kuyken (2009) lends support to this claim, concluding that as much as 15% of the variance in the outcome may be attributed to how effectively therapists conduct treatment
This is a limitation as if you have a therapist that you may consider ‘bad’, or cannot provide the extreme environment required for CBT, it is less likely that your treatment will be effective
Ineffective treatments may then put people off from reaching out for further support, as they will think it will also be ineffective
OCD Definition
The DMI-5 recognises OCD and a range of relate disorders that all have obsessive thoughts accompanied by repetitive behaviour
1 - OCD
OCD is a mental health disorder that is characterised by repetitive actions that seem impossible to stop
- the O stands for obsessions that are an unpleasant thought that enters the mind that causes anxiety and disgust
- the C stands for compulsions that are repetitive behaviours that the individual carries out to relieve the unpleasant feelings
Hoarding Disorder
A category of OCD recognised by the DMI-5
A disorder that is characterised by difficulty with parting with or discarding possessions
- it is considered as being a problem if the amount of clutter interferes with every day living or causes significant distress or negatively affects quality of life
Trichotillomania
A category of OCD recognised by the DMI-5
A mental disorder which presents as repeated and uncontrolled urge to pull out body hair
More commonly it is seen in teens and young adults
It can be a done as a response to stress and can be done without thinking about it
Excoriation Disorder
A category of OCD recognised by the DMI-5
A disorder where a person feels compelled to pick at their skin to the point where it causes visible wounds
They usually pick at the skin on their face and lips, but it can be anywhere on the body
They can also pick at moles and freckles
Behavioural Characteristics of OCD
The behavioural component of OCD is compulsive behaviours
A compulsion is a behaviour, it is something you do
The three we need to know about are:
- compulsions are repetitive
- compulsions reduce anxiety
- avoidance
Behavioural Characteristics of OCD - Compulsions are Repetitive
Typically, people with OCD feel compelled to repeat behaviours
A common compulsion is hand washing, but others include:
- counting
- praying
- tidying and organising groups of objects, such as collections (for those who have them) or containers in a food cupboard
Behavioural Characteristics of OCD - Compulsions Reduce Anxiety
Around 10% of people with OCD show compulsive behaviour alone
- they have no obsessions, just a general sense of irrational anxiety
But for the vast majority, compulsive behaviours are performed in an attempt to manage anxiety produced by obsessions
- e.g. 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 off, is in response to the obsessive thought that it might have been left unsecured
Behavioural Characteristics of OCD - Avoidance
Behaviour of people with OCD may also be characterised by their avoidance as they attempt to reduce anxiety by their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger it, managing their OCD this way
- e.g. people with OCD who wash their hands compulsively may avoid coming in to contact with germs
However, this avoidance can lead to people to avoid very ordinary situations, such as emptying their rubbish bins, and this can in itself interfere with leading a normal life
Emotional Characteristics of OCD
OCD is categorised as an anxiety disorder
There are three emotional characteristics we need to know about:
- anxiety and distress
- accompanying depression
- guilt and disgust
Emotional Characteristics of OCD - Anxiety and Distress
OCD is regarded a 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 (a compulsion) creates anxiety
Emotional Characteristic of OCD - Accompanying Depression
OCD is often accompanied by depression, so anxiety can be accompanied by low mood and a lack of enjoyment in activities
Compulsive behaviour tends to bring some relief from anxiety, but this is temporary
Emotional Characteristics of OCD - Guilt and Disgust
As well as anxiety and depression, OCD sometimes includes other negative emotions such as irrational guilt
For example, over minor moral issues
They may also feel disgust, which may be directed against something external like dirt or at the self
Cognitive Characteristics of OCD
Obsessions are cognitive
People with OCD are often plagued with obsessive thoughts, but they also develop cognitive strategies to deal with these
There are three we need to know about:
- obsessive thoughts
- cognitive coping strategies
- insight into excessive anxiety
Cognitive Characteristics of OCD - Obsessive Thoughts
For around 90% of people with OCD, the major feature of their condition is obsessive thoughts
- i.e. thoughts that recur over and over again
These vary considerably from person to person but they are always unpleasant
Examples of recurring thoughts are worried of being contaminated by dirt of germs, or certainty that a door has been left unlocked and intruders will enter through it, or impulses to hurt someone
Cognitive Characteristics of OCD - Cognitive Coping Strategies
Obsessions are the major cognitive aspect to OCD, but people also respond by opting cognitive coping strategies to deal with obsessions
For example, a religious person tormented by obsessive guilt may respond by praying or meditating
This may help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks
Insight into Excessive Anxiety
People with OCD are aware that their obsession and compulsions are irrational
- in fact, this is necessary for a diagnosis of OCD
- if someone really believed their obsessive thoughts wee based on reality, that would be a symptom of a quite different form of mental disorder
However, in spite of this, people with OCD experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified
They also tend to be hypervigilant
- i.e. they maintain constant alertness and keep attention focused on potential hazards
Genetic Explanations for OCD
This is the idea that mental illnesses such as OCD are inherited
There is a lot of evidence that suggests that OCD does indeed have a genetic basis, as shown by family studies, where we look at whether a condition runs in a family
- twin studies are a specific type of family study)
Family studies work by comparing the concordance rate
- i.e. if one family member has OCD, the likelihood of another family member also being effected by OCD
If there is a genetic component to OCD then we would expect to see a positive correlation between degree of genetic similarity and concordance rate for OCD
- i.e. the more closely related you are to someone with OCD, the greater the likelihood that you also have it
Genetic Explanations of OCD - Research
In a classic piece of research, Lewis (1936) found that of his OCD patients, 37% had parents withy OCD and 21% had siblings with OCD
This suggests that that genes do play a role in OCD
- it does seem to run in families
However, as the concordance rate isn’t higher (50%), OCD can’t be only genetic
So, OCD has a genetic vulnerability
For OCD to develop, you need an environmental trigger
Genetic Explanations of OCD - Candidate Genes
The next logical step would be to identify the candidate genes
- i.e. genes that create a vulnerability for OCD
Some of these candidate genes for OCD are involved in regulating the development of the serotonin system
- e.g. SERT genes (such as the 5HT1-D gene)
The SERt gene is linked to the neurotransmitter serotonin and affects the transport of serotonin, causing lower levels of serotonin which is also associated with OCD
However, it appears that a number of different genes are involved in increasing a vulnerability to OCD
- i.e. OCD is polygenic
For example, Taylor (2013) analysed findings of previous studies and found evidence for up to 230 different genes being involved in OCD
This includes that genes associated with dopamine activity, as well as serotonin levels, such as the COMT gene
One variation of the COMT gene results in higher levels of dopamine and this variation is more common in patients with OCD, in comparison to people with OCD
Genetic Explanations of OCD - Aetologically Heterogenous
It is also important to note here that OCD is aetologically heterogenous which means that there are differences in the causes of OCD from person to person
For example, one group of genes may cause OCD in one person, but a different group of genes may cause it in another person
Different types of OCD (e.g. hoarding disorder) may be a result of a particular genetic variation
Neural Explanations of OCD
The genes associated with OCD are likely to affect both the levels of key neurotransmitters as well as structures of the brain
Neural explanations suggest that abnormal levels of neurotransmitters are implicated with OCD
- such as serotonin and dopamine
Neural explanations also suggest that particular regions of the brain, in particular the frontal lobe and parahippocampal gyrus, are implicated in OCD
The Role of Serotonin (Neurotransmitters) in OCD
The idea that serotonin may play a role in OCD comes from:
1 - Genetic research
- SERT gene - differences on this gene can lead to reduce serotonin activity
2 - the fact that antidepressants (which essentially work by increasing levels of serotonin) can help people with OCD
- this does make sense given that serotonin is thought to regulate anxiety, happiness and mood
So, there may be a reduction in the functioning of the serotonin system in people withy OCD
Neural Explanations of OCD - Brain Structure
There are certain areas of the brain that are linked to OCD
Parahippocampal Gyrus is associated with processing unpleasant events
Lateral Frontal Lobes are associated with logical thinking and rational decision making
These are referenced in cognitive neuroscience
OCD Explanations Summary
OCD (obsessive compulsive disorder) had been explained in a number of ways, but the biological approach offer particularly useful suggestions as to how it is caused
The genetic explanation suggests that whether or not a person develops OCD is at least partly due to their genes
- this may explain why people with OCD often have other family members with OCD
OCD is thought to be polygenic, meaning that development is not determined by a single gene, but by a few
Candidate genes are ones which, through research, have been implicated in the development of OCD
These genes tend to be involved in regulating serotonin, a neurotransmitter which facilitates message transfer across synapses
However, it is recognised that not everyone in a given family gets OCD, so there must be additional factors
The diasthesis-stress model suggests that people gain a vulnerability towards OCD through genes but an environmental stressor is also required
This could be a stressful event, such as a bereavement
Neural explanations of OCD focus on the role of neurotransmitters and the structure of the brain
For example, some cases of OCD may result from low levels of serotonin in the brain which affects the transmission of mood-related information
Finally, research has also suggested that OCD may result from impairment of the frontal lobes which control your decision making
Strength for Genetic Explanations of OCD
One strength of the genetic explanation for OCD is the strong evidence base
For example, there is evidence from a variety of sources which strongly suggests that some people were vulnerable to OCD as a result of their genetic makeup. One source of evidence is twin studies. In one study, Nestadt et al (2010) reviewed twin studies and found that 68% of MZ twins shared OCD, compared to 31% of DZ twins. Another source of research for a genetic influence on OCD comes from a more recent family study research which found a person with a family member diagnosed withy OCD is around four times more likely to develop it as someone with no family members with OCD
This is a strength because these research studies suggest that there must be some genetic influence on the development of OCD
Limitation for Genetic Explanation of OCD
One limitation of the genetic model of OCD is that while there is a strong evidence for the idea that genetic variation can make a person more or less vulnerable to OCD, OCD does not appear to be entirely genetic in origin, and it does seem that environmental risk factors can also trigger or increase the risk of developing OCD
For example, in one study it was found that over half of the OCD clients in a sample had experienced a traumatic event in their past. OCD was also more severe in those with one or more traumas
This is a limitation because it means that genetic vulnerability only provides a partial explanation of OCD
Genetic Explanations of OCD - Extra Evaluation
Animal Studies
It is proved difficult to find genes i.e. genetic variations that are possible cause of OCD
There is evidence though 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 mind and brain are much more complex, and it may not be possible to generalise from animal repetitive behaviour to human OCD
Strength of Neural Explanations for OCD
One strength of the neural model of OCD is the existence of some supporting evidence
For example, antidepressants that work purely on serotonin are effective in reducing OCD symptoms and this suggests that serotonin may be involved in OCD. One review of 17 studies compared treating OCD with antidepressants vs placebos and all 17 studies showed significantly more improvement for those taking the antidepressants compared to those taking the placebos
This is a strength because it does suggest that neural factors such as serotonin may play a role in OCD
Limitation of the Neural Explanation of OCD
One limitation of the neural model is that the serotonin-OCD link may not be unique to OCD
For example, many people with OCD also experience depression (there is a co-morbidity, i.e. having two disorders together). Depression is also linked to lower levels of serotonin activity
This is a limitation because it leave us with the problem that the disrupted serotonin activity we see in people with OCD is a result of the depression rather than OCD
Extra Evaluation for Neural Explanations of OCD
Correlation and Causality
There is evidence to show that some neural systems (such as serotonin) do not work normally in people with OCD
According to the biological model of mental disorders this is mostly easily explained by brain dysfunction causing the OCD
However, this is simply a correlation between neural abnormality and OCD, and such correlations do not necessarily indicate a casual relationship
It is quite possible that the OCD (or its accompanying depression) causes the abnormal brain function or both are influenced by a third factor
Drug Therapy for OCD
Drug therapy for mental illnesses aim to increase or decrease levels of neurotransmitters in the brain to increase or decrease their activity
In OCD, drug therapy aims to increase serotonin levels
Drug Therapy for OCD - SSRIs
SSRIs (selective serotonin reuptake inhibitors) are the standard medical treatment to tackle the3 symptoms of OCD
A common one prescribed is flouxetine (Prozac), with a typical daily does of 20mg
- although this can be increased to 40mg or 60mg is needed
It comes in both tablet and liquid form
It does not work instantaneously, it may take 3-4 months of daily use to start to have an impact on the symptoms and
How SSRIs Work
In the synapses, neurotransmitters carry the signal for electrical impulses to the next neurone
Once they gave done this, they travel back up the synapse and are reabsorbed by the pre-synaptic neurone an then broken down
SSRIs prevent the reabsorption and stops them being broken down
This in turn increases the amount of serotonin in the synapse which will mean the post-synaptic neurone will be stimulated
SSRIs + Other Treatments
SSRIs are often used alongside CBT to treat OCD
This is done because it will help the management of their OCD in the long-term as well as the fact that two therapies are more likely to help than one
Alternatives to SSRIs
It may be that the SSRIs are not effective for an individual, even if dosages have been altered or they have been combined withy other drugs
In this case, different types of antidepressants might be used, which include tricyclics and SNRIs
Tricyclics:
- older and not first course of treatment anymore
- increase neurotransmitters
- may work better than SSRIs in people with severe depression and in those being treated inpatient
- adverse side effects and lethal in overdose quantities
SNRIs:
Drug Therapy for OCD - Evidence of Effectiveness
One strength of drug treatment for OCD is good evidence for effectiveness
There is clear evidence to show that SSRIs reduce symptom severity and improve quality of life for people with OCD. For example, G. Mustafa Soomro et al. (2009) reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD. All 17 studies showed significantly better outcomes for SSRIs than the placebo conditions. Typically symptoms reduce from around 70% of people taking SSRIs. For the other 30%, most can be helped by either alternative drugs or combinations of drugs and psychological therapies.
This means that drugs appear to be helpful for most people with OCD
However, there is some evidence to suggest that even if drug treatments are helpful for most people with OCD, they may not be the most effective treatments available
Petros Skapinakis et al. (2016) carried out a systematic review of outcome studies and concluded that both cognitive and behavioural (exposure) therapies were more effective than SSRIs in the treatment of OCD
This means that drugs may not be the optimum treatment for OCD
Drug Therapy for OCD - Cost-Effective and Non-Disruptive
One further strength of drugs is that they are cost-effective and non-disruptive to people’s lives
A strength of drug treatments for psychological disorders in general is that 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 psychological therapy. Using drugs to treat OCD is therefore good value for public health services like the NHS and represents a good use of limited funds. As compared to psychological therapies, SSRIs are also non-disruptive to people’s lives. This is quite different from psychological therapy which involves time spent attending therapy sessions
This mean that drugs are popular with many people with OCD and their doctors
Drug Therapies for OCD - Serious Side-Effects
One limitation of drug treatments for OCD is that drugs can have potentially serious side-effects
Although drugs such as SSRIs help most people, a small minority will get no benefit. Some people also experience side-effects such as indigestion, blurred vision and 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 in 10 people experience erection problems and weight gain, 1 in 100 become aggressive and experience heart-related photos
This 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
Drug Therapy for OCD - Biased Evidence
There is always some controversy over the evidence used for the effectiveness of drugs. Some psychologists believe that the evidence for drug effectiveness is biased because researchers are sponsored by drug companies and may selectively publish positive outcomes for the drugs their sponsors are selling (Goldcare 2013)
On the other hand, there is a lack of independent studies of drug effectiveness and also research on psychological therapies may be biased. The best evidence available is supportive of the usefulness of drugs for OCD
