psychopathology

Question 1

Outline statistical infrequency as an explanation of abnormality

Answer 1

Occurs when an individual has a less common, numerically rare characteristic.

Question 2

Evaulate Statistical infrequency as an explanation for abnormality [2]

Answer 2

STRENGTH
- almost always used in the clinical diagnoses of mental health disorders as a comparison with a baseline or ‘normal’ value.
- used to assess the severity of the disorder
e.g. the idea that Schizophrenia only affects 1% of the general population,
: subtypes even less common : e.g paranoid sz

LIMITATION
- assumption that any abnormal characteristics are automatically negative, whereas this is not always the case
e.g displaying abnormal levels of empathy ( Highly Sensitive Person) or
having an IQ score above 130 (and thus being a genius) would rarely be looked down upon as negative characteristics requiring treatment

Question 3

Outline the failure to function adequately definition of abnormality

Answer 3

Rosenhan and Seligman 1989
- if a persons current mental health prevents them from leading a “normal life” + normal levels of motivation and obedience to social norms

-does not obey social and interpersonal rules
-in distress or are distressing
-behaviour has become dangerous (to themselves/others)

Question 4

Evaluate the failure to function adequately definition of abnormality

Answer 4

STRENGTH
-takes into account patients
perspective
-final diagnosis will consist of patient’s subjective self reported symptoms in addition to psychiatrics opinion
-more accurate diagnosis : not constrained by statistical limits (statistical infrequency)

LIMITATION
-may lead to the labelling of some patients as “strange” or “crazy” : does little to challenge traditional negative stereotypes about MHD
- not everyone with a MHD requires diagnosis : e.g high quality of life & little impact upon themselves and others
- such labelling can lead to discrimination and prejudice faced in real world (e.g work employment)

Question 5

Outline the deviation from social norm definition of abnormality

Answer 5

• straying away from social norms specific to a culture
  general norms : applicable to vast majority of cultures & culture specific norms
  e.g
  could be diagnosed with antisocial personality disorder (APD) when aggressive to strangers (general socal norm)

hallucinations : breaching social norm in many cultures however other cultures may encourage this as a sign of spirituality

Question 6

Evaluate deviation from social norm definition of abnormality

Answer 6

STRENGTH
- used in clinical practise
e.g: the key to defining characteristics of APD is failure to conform to culturally acceptable ethical behaviours (e.g : aggression and violating others rights)
in addition : used to diagnose schizotypal personality disorder : characteristics are described as “strange”
-has value in psychiatry

LIMITATION
-reliance on subjective social norms : explanation suffers from cultural relativism
- e.g hearing hallucinations : some asian/african cultures would encourage such symptom positively
-viewing it as a sign of spirituality : strong connection to ancestors as opposed to a symptom of SZ
- may lead to discrepancies in diagnosis about MHD between cultures

Question 7

Outline the deviation from ideal mental health as an explanation for abnormality

Answer 7

Jahoda (1958)

-focuses on what would compromise ideal mental health , abnormal when critirea not reached
-criteria involves :
- self actualise , accurate perception of reality , not being distressed , motivation to carry out d-t-d tasks and displaying high self esteem
-resistance to stress

the more criteria someone fails to meet, the more abnormal they are.

Question 8

Evaluate deviation from ideal mental health as an explanation for abnormality

Answer 8

LIMITATION:
-unrealistic expectation of ideal mental health ; vast majority are unable to acquire , let alone maintain all criteria
-majority pop considered abnormal : even when missing one criteria
e.g rationally being able to cope with stress : does not merit a diagnosis
- limited method of diagnosing MHD

LIMITATION
-suffers from cultural relativism
-concept of self-actualisation (we must put ourselves first in order to achieve our full potential) can be viewed as selfish in collectivist cultures (china) : needs of group valued more than needs of individual
- SA more popular in individualist cultures (UK) : personal achievements celebrated (individual success greater)
- only a definition of abnormality in some individualist cultures

Question 9

Outline the behavioural characteristics of phobias

Answer 9

panic - heightened physiological arousal upon exposure to the phobic stimulus,

Avoidance — negatively reinforced (in classical conditioning terms) because it is carried out to avoid the unpleasant consequence of exposure to the phobic stimulus.

• severely impacts the patient’s ability to continue with their day to day lives. Especially if the phobic stimulus is often seen (e.g public places)

endurance remaining in the prescense of PS

Question 10

Outline the emotional characteristics of phobias

Answer 10

anxiety - (the emotional consequence of the physiological response of panic)

fear- immediate and unpleasant response experienced upon exposure or thoughts about PS : high intensity but shorter period than anxiety

unawareness that the anxiety experienced towards the phobic stimulus is irrational- from an evolutionary perspective, the phobic anxiety is not proportionate to the threat posed by the stimulus

Question 11

Outline the cognitive characteristics of phobias

Answer 11

SAPSIBCD

Selective attention— patient remains focused on the phobic stimulus, even when it is causing them severe anxiety. This may be the result of irrational beliefs or cognitive distortions.

Irrational beliefs — this may be the cause of unreasonable responses of anxiety towards the phobic stimulus, due to the patient’s incorrect perception as to what the danger posed actually is.

Cognitive distortions — the patient does not perceive the phobic stimulus accurately. Therefore, it may often appear grossly distorted or irrational e.g. mycophobia (a phobia of mushrooms)

Question 12

Outline systematic desensitisation as a treatment for phobias

Answer 12

-behavioural therapy designed to reduce phobic anxiety
-gradual exposure to PS
-relies on principle of
counterconditioning: learning new response to PS : e.g relaxation rather than panic
- works due to:
reciprocal inhibition: impossible to be both relaxed and anxious at the same time

1). patient and therapist draw up a anxiety hierachy : situations involving PS ordered from least to most nerve-wracking
2). therapist teaches patients relaxation techniques: e.g meditation
3). patient works their way up hierachy: progressing to next level when remained calm at present level
4) phobia “cured” when remained calm at highest lvl

Question 13

Outline flooding as a treatment for phobias

Answer 13

-behavioural therapy designed to reduce PS anxiety in one session
-immediate exposure to PS
-secure environment : patient cannot escape:
-this inhibits the practise of avoidance behaviour : behaviour is not reinforced so cannot be maintained

-based on the principle that it is physically impossible to maintain a state of heightened anxiety for a prolonged period of time : patient will learn the PS is harmless

e.g : spider phobia
- instantly exposed to room full of spiders
-spiders can crawl over them

extinction of fear response occurs.

Question 14

EVAL POINTS FOR SYSTEMATIC DESENSITISATION

Answer 14

STRENGTHS
+ Supporting evidence = Gilroy et al.
+ Systematic desensitisation is suitable for many patients, including those with learning difficulties
+Economical implications

*WEAKNESSES**
not so effective for phobias of situations or concepts,

Question 15

Outline a strength of systematic desensitisation (supporting evidence)

Answer 15

supporting evidence :Gilroy et al
-42 patients treated in 3 sessions of SD for a spider phobia : progress compared to a control group of 50 patients who learnt only relaxation techniques
-extent of phobia measured through a questionnaire and observation
-at both 3 and 33 months the SD group showed a reduction in symptoms compared to CG
-this is evidence to support the effectiveness of SD
CP : small sample size

Question 16

Outline a strength of systematic desensitisation (suitability)

Answer 16

-suitable for many patients including those with learning disabilities
-anxiety disorders usually accompanied with learning disabilities
- will not be able to make the full cognitive commitment to CBT or ability to evaluate own thoughts
-SD is a particularly suitable alternative for them

Question 17

Outline a strength of systematic desensitisation (economics)

Answer 17

• positive economical implications
  -more acceptable to patients : as shown by low refusal and attrition rates
  -increases likelhood that patient will commit to continuing their therapy as opposed to getting “cold feet” : wasting time and effort of the therapist

gradual process of the therapy allows respite – the relaxation is pleasant.

Question 18

Outline a weakness of systematic desensitisaton as a treatment for phobias

Answer 18

• works best for phobias of objects or animals
  -however : not effective for phobias of situations/concepts e.g fear of crowds or germs
• may be due to : hard to recreate these things in therapy session : hard too manipuate these things into a stimulus hierachy. (e.g fear of flying)
  -limited explanation

Question 19

Evaluate a strength of flooding as a treatment for phobias

Answer 19

Cost-effective
- ougrin compared flooding to cognitive therapies and found it to be cheaper

-patients phobia typically cured in one session ; free of symptomps
-can continue day to day life

Question 20

Evaluate a weakness of flooding as a treatment for phobias

Answer 20

less effective for complex phobias
- Social phobias involve both anxiety and a cognitive aspect (e.g unpleasent thoughts ab a situation)
- cognitive therapy may be more appropriate in these situations : can target the root of the phobia rather than indirect cause
-alternatives may be more effective

Question 21

Outline the behavioural approach to explaining phobias

Answer 21

Mowrer 1960
-suggested: phobias are acquired through CC and then maintained through OC
-Watson and Rayner demonstrated Little Albert associating fear caused by a loud bang with a white rat

TWO PROCESS MODEL
- exposed to white rat (NS) > LOUD BANG (UCS) > (UCR) fear
-several repetitions: albert made the association between the rat (CS) and fear (CR)
-fear was generalised to other white objects

-OC takes place when behaviour is rewarded/punished : phobics practise avoidance behaviours: thus avoiding PS
-avoiding PS: avoiding associated fear
-by avoiding such unpleasent consequence the avoidance behaviour is negatively rienforced : more likely to happen again
-this maintains the PS

Question 22

Evaluate a strength of the behavioural approach to treating phobias

Answer 22

good explanatory power
-can explain mechanism behind acquisition and maintenance of phobias ; CC and OC alone cannot do

-translates into practical benefits in SD and flooding ; Mowrer emphasised the importance of exposing the patient to PS because this prevents negative reinforcement and avoidance behaviour

• patient realises PS is harmless and that their responses are disproportionate : successful therapy

Question 23

Evaluate a limitation of the behavioural approach to explaining phobias (alternative explanation (buck)

Answer 23

Bucks alternative explanation
-safety is a greater motivator for avoidance behaviour , rather than avoiding anixety avoided w PS
-e.g : used example of social anxiety phobias
- sufferers can venture out into public with a trusted friend despite exposure to triggering stimuli ( strangers/crowds) that could trigger anxiety
-incomplete explanation : suited only for some

Question 24

Evaluate a limitation of the behavioural approach to explaining phobias (acquisition alternative explanation)

Answer 24

Alternative explanation for the acquisition of phobias

-Seligman: suggested : more likely to develop phobias towards “prepared stimuli” : phobias posed threat to evolutionary ancestors e.g deep water or fire

-running away/phobia from such stimuli: increased chances of survival & reproduction: thus an evolutionary advantage

-suggests why some phobias (prep stimuli) are much more frequent than others

(cannot explain why we seem to be pre-prepared to fear certain stimuli)

Question 25

Outline the behavioural characteristics of depression

Answer 25

changed activity levels -
may result in psychomotor agitation or, on the other end of the spectrum, an inability to wake up and get out of bed in the morning

aggression-
towards oneself and towards others, which may be verbal or physical)

changed in patterns of sleeping and eating
insomnia and obesity on one end of the spectrum, whilst constant lethargia and anorexia may appear on the other

Question 26

Outline the emotional characteristics of depression

Answer 26

• lowered self esteem
• constant poor mood :
  lasting for months at a time and high in severity, therefore not simply ‘feeling down’

-high levels of anger
towards oneself and towards others

Question 27

Outline the cognitive characteristics of depression

Answer 27

absolutist thinking -
jumping to irrational conclusions e.g. “I am unable to visit my mother today and so I am a failure of a son”

selective attention towards negative events -
patients with depression often recall only negative events in their lives, as opposed to positive

poor concentration -
the consequent disruptions to school and work add to the feelings of worthlessness and anger

Question 28

Outline BECKS cognitive approach to explaining depression

Answer 28

Becks negative triad
- one has a cognitive vulnerability towards developing depression through:
- faulty information processing: patient blows small problems out of proportion, attending to and dwelling on the negative, whilst thinking in ‘black and white’ terms.

-negative self schemas: atient interprets all information about themselves from the world in a negative light, further lowering their self-confidence

-cognitive triad of automatic negative thoughts: patient suffers from negative automatic thoughts about the self, the future and the world

Question 29

Outline ELLIS cognitive approach to explaining depression

Answer 29

Rational emotive behavioural therapy

Ellis proposed that an activating event (A), leads to an irrational belief (B), which results in an emotional consequence (C) in the form of depression.

The key here is the specific interpretation of the irrational belief, which is why some people have depression, whilst others don’t, according to the ABC model.

Question 30

Evaluate a strength of becks cognitive theory (supporting evidence)

Answer 30

Supporting research evidence

Grazioli and Terry’s evaluation of 65 pregnant women for cognitive vulnerability and depression before and after birth.

positive correlation between an increased cognitive vulnerability and an increased likelihood of acquiring depression after birth.

(found that those women with high cognitive vulnerability were most likely to suffer from post- natal depression.)

supports the link between faulty cognition and depression, which is in line with the predictions made by Beck’s cognitive theory, thus increasing the validity of this theory.

Question 31

Evaluate a strength of becks cognitive theory (effective treatment)

Answer 31

effective treatments

-increased understanding of cognitive basis of depression translates to effective treatments
-e.g elements of cognitive traid can be identified by therapist and challenged as irrational thoughts
-translates well into a successful therapy
-consequent effectiveness of CBT : due to accuracy of Becks CT

Question 32

Evaluate weakness of the cognitive explanation of depression

Answer 32

both ABC and Becks cognitive theory :
-cannot explain all aspects of depression (hallucinations , Cotard syndrome)
e.g s
ome types of depression may be caused by chemical imbalances in the brain or other physiological factors. (hallucinations : psychological , biological etc)

-difficult practical issue
-patients may become frustrated that their symptoms cannot be explained according to this theory and therefore cannot be addressed in therapyy

Question 33

Evaluate one weakness of Ellis cognitive explanation for depression

Answer 33

ABC model cannot explain all types of depression : only those which clearly have an activating event (reactive depression)

• many suffer from depression w/o an apparent cause : may feel frustrated that their concerns/experiences are not reflected in this theory
  -limited explanation

Question 34

Evaluate one strength of Ellis cognitive explanation for depression

Answer 34

-practical application in CBT

-effectiveness of CBT suggests : identifying and challenging irrational beliefs are at the core of ‘curing’ depression, which in turn supports the theoretical basis of the ABC model

-focuses on role of faulty cognition in the development of depression : INTERPRETATION OF ACTIVATING EVENT

Question 35

Outline Beck’s CBT for treating depression

Answer 35

Beck’s CBT aims on identifying the patient’s thoughts and challenging them as irrational.

• replacing them with more productive behaviours , thus treating depression
  -can be guided by the cognitive triad of automatic negative thoughts (future self and world)
  -faulty info processing and negative self schemas
• CBT aims for patients to test the reality of their beliefs

-involves behavioural and cognitive aspect (identifying where the irrational thought is)

For example, a patient may record each time someone was nice to them for the past week (setting the patient homework). Next time they say that everyone hates them, the therapist can point towards the journal as counter-evidence, thus proving the patient’s beliefs as irrational. This demonstrates the idea of ‘patient as scientist’

Question 36

Outline Ellis cognitive treatment for depression

Answer 36

Ellis’s rational emotive behaviour therapy

aims to identify the patient’s thoughts and challenge them as irrational, leading to a vigorous argument.

logical argument i.e the belief doesn’t follow on logically from the facts
empirical argument there is no evidence to support the irrational belief

-change the irrational belief and
-break the link between negative life events and depression.

Through behavioural activation, patients are encouraged to engage in enjoyable activities, to provide further counter-evidence for their irrational beliefs.
(decrease avoidance and isolation)

Question 37

Evaluate a strength of the cognitive treatment for depression

Answer 37

Supporting evidence
- March et al
-group of 327 adolescents with a main diagnosis of depression
- studieed effectiveness of CBT and antidep treating depression

-after 36 weeks :
81% : CBT
81% : antidepresseents
86%: antidep and CBT
- compelling evidence to suggest CBT can b just as effective as medication

good case for making CBT the first choice of treatment in public health care systems like the NHS.

Question 38

Evaluate a weaknesses of the cognitive approach to treating depression (present life)

Answer 38

focus on present life and challenges which present life presents (the cognitive approach)

• assumes patients current circumstances are responsible for their depression
• however considerable amount can be due to past events : traumatic life events or death of loved one can be responsible
  -CBT therapists unwilling to “dwell on the past” : may become frustrated that they have little input/say ab how their therapy is brought about

Question 39

Outline the behavioural characteristics of OCD

Answer 39

compulsions-
repetitive: they feel compelled to repeat behaviour
Performing compulsions reduce the sense of irrational anxiety produced by their obsessions. (e.g rechecking a door is locked

avoidance behaviour-
negatively reinforced (in terms of classical conditioning) because an individual who avoids the specific stimulus will avoid the anxiety associated with having to carry out compulsive behaviours and suffer from obsessive thoughts.

Question 40

Outline the emotional characteristics of OCD

Answer 40

guilt and disgust, depression -
due to the constant compulsion to carry out obsessive/repetitive behaviours, which often interfere with day to day functioning and relationships

anxiety -
associated with the acknowledgement that the obsessive thoughts are irrational, but despair at the fact that they will always lead to compulsive behaviours

Question 41

Outline the cognitive characteristics of OCD

Answer 41

the patient’s acknowledgement that their anxiety is excessive and irrational-
(a hallmark of OCD)

development of cognitive strategies to deal with obsessions-
such as always carrying multiple bottles of hand sanitiser
-reduces anxiety

obsessive thoughts -
unpleasant and catastrophic recurring intrusive thoughts.
cause excessive amounts of anxiety and lead to compulsive behaviours

Question 42

Outline the genetic explanation to explaining OCD

Answer 42

diathesis-stress model : suggests that some have a genetic vulnerability towards developing depression.

Lewis et al. found that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD.

OCD is polygenic, meaning that up to 230 different genes are involved in its development (Taylor).
- These are often associated with the functioning of neurotransmitters, such as dopamine and serotonin, both associated with regulating mood.

candidate genes which increase a person’s vulnerability towards developing OCD :
5HT1-D beta, which is implicated in the efficiency of serotonin transport across synapses.

OCD is also aetiologically heterogenous, meaning that its origin has many different causes.
For example, it has been suggested that hoarding disorder is caused by a particular genetic variation.

Question 43

Evaluate a strength of the genetic explanation for OCD

Answer 43

Supporting evidence - Nestadt et al.

-reviewed previous twin studies of OCD
-found :68% of identical twins, compared to 31% of non-identical twins, share OCD

-suggests : genetic basis for this disease : MZ twins = 100% and DZ twins only 50% genes shared

CP: important to not be deterministic
-not “doomed” to developing OCD due to particular combination of candidate genes
-needs to be paired with an environmental stressor (DSM)

Question 44

Evaluate a limitation of the genetic explanation for OCD

Answer 44

Too many candidate genes
With over 230 candidate genes each individually coding for an increased risk of OCD,
-poses a practical issue in that it is difficult to assess which candidate genes have the greatest influence and so which genes drug treatments should target.

Thus, such an explanation is likely to have little predictive value in the future.

Question 45

Evaluate a limitation of the genetic explanation for OCD (trauma)

Answer 45

ignores environmental factors
-Cromer et al : of his OCD patients : over half had experienced a trauma in their lives

• positive correlation between increasing number of traumas and increasing severity of the OCD which patients suffered from

Question 46

Outline the neural explanation for OCD : (neurotransmitters )

Answer 46

• lower levels of serotonin associated with OCD : role of preventing repetitive behaviours
• lack of serotonin : loss of mechanism that inhibits task repetition

-Pigget et al: antidep drugs with serotonin have shown to reduce OCD symptoms reduce OCD sympt : negative corr between less serotonin and increased obsessive thoughts

Question 47

Outline the neural explanation for OCD: (abnormal brain circuits)

Answer 47

-neuroimaging techniques : identify abnormal patterns in brain

• damage to decision making systems in the frontal lobe : abnormal in people with OCD
• OFC worry signals (e.g germ hazard) when basal ganglia is damaged it fails to oppress the worry circuit of the OFC

-Thalamus is alerted and confirms the worry of OFC creating a worry circuit : obessive behaviours

Question 48

Outline strength of neural explanation for OCD

Answer 48

Research support
-Paul et al
-neuroimaging : repeatedly found unusually high activation within OFC ; supported by further studies identifying excessive activity in basal ganglia in OCD patients + PET scans when OCD was actve

• strong objective & empirical evidence : certain brain circuits associated w OCD
• increased validity

Question 49

Outline a weakness of neural explanation for OCD

Answer 49

relies on correlation rather than causation
-research into brain studies show an association between increased activity in certain brain areas (OFC) and OCD

-does not guarantee a causational relationship for OCD
-biological abnormalities can be a CONSEQUENCE of OCD rather than the cause

-OCD may be explained by other approaches: raises qs ab validity

Question 50

Outline the biological approach to treating OCD

Answer 50

• selective serotonin reuptake inhibitors (SSRIs) :
  act on the serotonin system by preventing the the reabsorption and breakdown of serotonin in the brain

-concentration of serotonin within the synapse increases causing the post synaptic neuron to be continually stimulated.
- timescale of 3-4 months to see effects

• Tricyclics :
  Have a similar effect by reserved for those who do not respond well to SSRIs
• Selective nonadrenaliseereuptake inhibitors (SNRIs):
  Increased the concentration of the nonadrenaline neurotransmitter in the brain

Question 51

Outline a limitation of the biological approach to treating OCD (side effects)

Answer 51

serious side effects of drug therapy
-Clomipramine : more than 1/10 suffer from erection problems , weight gain and tremors
-more than 1/100 suffer from increased heart rate and aggressive behaviour
-implications: patient goes about their day to day life

Question 52

Strength of biological approach to treating OCD

Answer 52

cost-effective and non-disruptive

• cheap compared to psychological treatments,
• prove to be good value for public health organizations like the NHS.
• also non-disruptive.
  Patients can discretely take the drugs to manage their symptoms and lead a relatively normal life, as compared to life in hospital.

Question 53

Outline a strength for the biological approach to treating OCD

Answer 53

positive economical implications
-increased knowledge ab certain drug treatments for OCD and CBT : reduces time people take off work through sick days

-increased productivity of work force :more people working: more people paying tax
-research can help public health services choose which treatments they use : help health organisations like NHS save money