Psychopathology Flashcards
What is the statistical infrequency definition of abnormality?
Any person’s measurement that falls out of the defined field (2 standard deviations away) can therefore have an abnormal characteristic. This isn’t always a negative thing.
Is the statistical infrequency definition of abnormality objective?
It is impartial and fair as there is an objective cut off point. eg: IQ is usually between 90 - 100. Therefore it is not subjective.
Is the statistical infrequency definition of abnormality black and white?
According to this definition, someone can only be placed in normal or statistically infrequent. Therefore this ignores a grey area, and maybe it should be on a spectrum.
Does the statistical infrequency definition of abnormality have practical applications?
Can help with a basis for diagnosis, and we can identify those who need treatment urgently. Therefore each individual gets a tailored diagnosis.
Does the statistical infrequency definition of abnormality account for all abnormalities?
Depression could be considered common - 20% suffer from a depressive episode at some point in their lifetime. This may prolong a sufferer’s experience.
What is the deviation from social norms definition of abnormality?
Abnormality is a social deviant behaviour. If behaviour is seen as abnormal, it is viewed by society as undesirable and anti-social, not rare.
Some rules are implicit whilst others are policed by laws.
Does the deviation from social norms definition of abnormality take into account different types of norms?
Takes into account situational and developmental norms so could be considered to be more holistic. For example it takes context into account, therefore more valid.
Is the deviation from social norms definition of abnormality subjective?
Subjective which limits validity. Different norms between individuals, such as queueing for British individuals. Does not allow for a fair and equal assessment.
Does the deviation from social norms definition of abnormality have practical applications?
It allows therapists to intervene when necessary to stop people acting in a way that will hinder their progress in society as they have a baseline of societal norms.
Are there issues around the concept of deviation from social norms as a definition of abnormality?
Norms change throughout time, such as masks during the pandemic. Definition of abnormality is era dependent.
What is the deviation from ideal mental health definition of abnormality?
You are abnormal if you don’t meet the criteria of ideal mental health.
Who came up with the six characteristics of ideal mental health?
Jahoda
What are the six characteristics of ideal mental health?
Positive attitude towards oneself
Accurate perception of reality
Autonomy
Resisting stress
Self-actualisation
Environmental mastery
Is the deviation from ideal mental health definition of abnormality refreshingly positive?
It does not look at deficits or negative aspects, as it helps individuals improve their own attitude without the need for professional help. It can be used as a more holistic definition.
Is the criteria for ideal mental health as a definition of abnormality too simplistic?
Majority considered abnormal by standards suggested. Humanism believes very few people achieve self-actualisation, definition may need to be more realistic.
Can we use the deviation from ideal mental health definition of abnormality to formulate a plan of action?
Ensure autonomy in small decisions. Criteria can be incorporated into everyday life so six criteria can be used effectively in therapy.
Are the criteria of ideal mental health important in all cultures?
High self esteem not important in collectivist cultures. Personal growth and autonomy may be more applicable to individualist cultures.
What is the failure to function adequately definition of abnormality?
Not functioning adequately causes stress and suffering for the individual - a person may not be coping with life in a normal way.
Who created the features of personal dysfunction?
Rosenhan and Seligman
What are the features of personal dysfunction?
Personal distress
Maladaptive behaviour
Unpredictability
Irrationality
Observer discomfort
Violation of moral qualities
Unconventionality
Is it easy to assess the consequences of failure to function adequately as a definition of abnormality?
If a person consistently fails to perform everyday actions this could mean they are failing to function in a societal manner. This can be assessed by a questionnaire - quantitative data makes definition more objective.
Is the failure to function adequately definition of abnormality influenced by subjective judgements?
What may seem to one person as failing to function adequately may not be the same to another. This implies the definition lacks generalisability.
Is the failure to function adequately definition of abnormality more realistic?
Suggests it is not black and white as a person may decline due to circumstances. It is well rounded due to its emphasis on environmental and societal factors.
Is the failure to function adequately definition of abnormality culturally relative?
What may seem as failing to function adequately in one culture may not be in another, depending on social norms/values.. This means we cannot generalise the explanation.
What is a phobia?
An intense, overwhelming and debilitating fear - very common, between 15 - 20% of the population experience one
What are emotional characteristics of phobias?
Persistent, excessive, unreasonable fear.
High level of anxiety when anticipating the object.
Fear when presented with stimulus.
What are behavioural characteristics of phobias?
Panic attacks, crying, screaming, running away, freezing or clinging.
Avoiding the feared stimulus.
Disrupting everyday functioning.
What are cognitive characteristics of phobias?
Conscious awareness of exaggerated anxiety.
Paying selective attention to the feared stimulus.
Irrational beliefs.
What is depression?
A mood disorder that causes a persistent feeling of sadness.
It is estimated that 5% of adults suffer from depression.
What are the emotional characteristics of depression?
Persistent low mood - pronounced feeling of sadness.
Anger directed at self and others.
Lowered self-esteem.
What are behavioural characteristics of depression?
Lack of interest in normal everyday activities / social withdrawal
Insomnia or excessive desire to sleep.
Aggression towards others.
What are cognitive characteristics of depression?
Poor concentration - difficulties attending to a task or problems making decisions
Cognitive biases - focus on negative aspects of a situation.
Suicidal thoughts.
What is OCD?
An anxiety disorder with obsessions and compulsions.
What are the emotional characteristics of OCD?
Anxiety and distress - may accompany both obsessions and compulsions.
Low mood and/or depression.
Feelings of guilt and disgust.
What are behavioural characteristics of OCD?
Compulsions - repetitive behaviours which are often performed in an attempt to reduce anxiety.
Avoidance of situations which trigger anxiety.
What are cognitive characteristics of OCD?
Obsessive thoughts which constantly occur.
Cognitive coping strategies.
Insight into obsessive anxiety.
What is the behaviourist approach to explaining phobias?
Association - (classical conditioning) - acquisition of phobia.
Consequences - (operant conditioning) - maintenance of phobias
What is classical conditioning?
Learning through association. Pairing a neutral stimulus with a response that creates an association between the two to create a conditioned stimulus. For example, getting bitten by a dog, then associating the pain of the bite with all dogs.
What is operant conditioning?
Learning via consequences. This refers to positive reinforcement (reward makes the behaviour increase) and negative reinforcement (taking away the unpleasant experience that makes the behaviour increase)
What is stimulus generalisation?
Can occur when anxiety can be generalised to all similar objects/situations.
What is higher order conditioning?
If a person avoids all phobic objects and associated situations this ultimately reduces their fear through negative reinforcement because now related situations have been associated with the phobic object.
Is there research evidence to support the behaviourist approach to explaining phobias?
Watson and Raynor’s Little Albert study found it was possible to condition a baby to fear a white rat by pairing it with a loud noise.
Also conditioned to fear all white furry things.
Supporting research to give an element of validity to theory.
Is the behaviourist approach to explaining phobias flawed?
Not all incidents of trauma result in phobias.
Some elements of cognition mediate the onset of phobia development.
Many people get stung by wasps but do not have a phobia of wasps.
Are there practical applications from the behaviourist approach to explain phobias?
Two process model: systematic desensitisation and flooding.
Stops the avoidance behaviour as the fear cannot be maintained.
Is the behaviourist approach to explain phobias environmentally reductionist?
It has been reduced down to simple stimulus/response from the complex behaviour.
Evolutionary explanations are ignored as some fears, such as the dark, used to keep us alive.
Are there alternative explanation to the behaviourist explanation of phobias?
Biological preparedness may be a better explanation.
Learning does not account for the fact that fears promoted survival.
Fear of some elements would ensure we keep safe (fear of snakes, spiders, the dark etc)
Is the behaviourist explanation of phobias scientific?
Two processes based on objective reliable data that focuses exclusively on behaviour.
The Little Albert study could be objectively observed.
Explanation offers scientific and trustworthy account.
Deviation from ideal mental health - positive attitude towards oneself
Having high self esteem and a strong sense of identity
Deviation from ideal mental health - accurate perception of reality
Not distorted by faulty thinking or delusions
Deviation from ideal mental health - autonomy
The ability to function as an independent person, taking responsibility for their own actions
Deviation from ideal mental health - resisting stress
Synthesising self-attitudes and personal growth to create resistance to stress.
Deviation from ideal mental health - self-actualisation
The extent to which a person develops their full capabilities.
Deviation from ideal mental health - environmental mastery
Including the abilities to love, function at work and interpersonal relations, adjust to new situations and solve problems.
Failure to function adequately - personal distress
The individuals themselves may suffer as a result of their condition, or inflict suffering on others.
Failure to function adequately - maladaptive behaviour
Behaviour prevents the person from reaching desired goals.
Failure to function adequately - unpredictability
Behaviour is unexpected and unpredictable
Failure to function adequately - irrationality
Behaviour seems to defy logical sense.
Failure to function adequately - observer discomfort
Behaviour makes those around the person feel uncomfortable.
Failure to function adequately - violation of moral qualities
Not behaving in accordance with society’s norms.
Failure to function adequately - unconventionality
Others find the behaviour odd.
What is the systematic desensitisation as a treatment for phobias?
The aim of the technique is to use the principles of association to replace the anxiety response with a relaxation response to help remove the phobia.
What are the stages of systematic desensitisation?
Fear hierarchy
Relaxation training
Graduated exposure
Reciprocal inhibition
What is a fear hierarchy?
Client and therapist construct a fear hierarchy which is a list of situations in which the client would feel anxiety, arranged from least to most.
What is relaxation training?
Client is taught different techniques for relaxing. This would include controlled breathing and progressive muscle relaxation.
What is graduated exposure?
Over the course of 6 - 12 sessions, the client is gradually brought into contact with their phobic situation or object. They would make their way up the fear hierarchy and use their relaxation training.
What is reciprocal inhibition?
Two opposite emotions cannot coexist at the same time.
What is in vitro and in vivo?
In vitro - the client imagines exposure to the phobic stimulus
In vivo - the client is actually exposed to the phobic stimulus.
Is there research evidence to support systematic desensitisation?
Worpe found a 91% success rate of the method in 39 cases.
The 9% was due to special cases that did not allow for proper treatment.
Is systematic desensitisation superficial?
Does not deal with the root cause of phobias.
Suppressing the symptoms may result in other symptoms appearing.
Could develop a further phobic response to new things.
Is systematic desensitisation ethical?
More ethical as based on classical conditioning - not like flooding.
Patients are given more control of procedure and will only move on when they are ready.
Is systematic desensitisation useful?
Complex/ social phobias do not respond well and relapse rates are high.
Crashe and Barlow found that between 60-80% only showed minor improvement and relapsed after 6 months.
What is flooding?
Based on classical conditioning, exposure is all at once opposed to gradual.
The aim of flooding is to expose the sufferer to the phobic object or situation for an extended period of time in a safe and controlled manner, and is usually done through in vivo methods.
What is the exposure of flooding?
Exposure is all at once opposed to gradual - expose the sufferer to the phobic object for an extended period of time in a safe and controlled manner.
What is the key principle of flooding?
Key principle is that fear is a time limited physical response - the initial strong bodily arousal caused by hormones can only last so long before the body calms down. The initial anxiety response becomes exhausted and extinct.
How does flooding eliminate the phobia?
Prolonged intense exposure creates a new association between the feared stimulus and response. Also prevents escape or avoidance.
Does flooding have supporting evidence?
Wolpe effectively used flooding to treat a girl’s phobia of cars by forcing her into a car and driving around for four hours.
Is flooding ethical?
Highly traumatic and high amounts of anxiety. Many cannot complete the treatment.
Can be dangerous for people with heart conditions, and children who the shock may affect long term.
Is flooding cost effective?
No therapy sessions needed so the original cost is worthwhile.
No demands on the NHS opposed to drug treatments which could cause side effects.
Is flooding effective?
Less effective at treating more complex phobias.
Social phobias involve more cognitive aspects than just the anxiety response.
What is Beck’s negative triad?
He suggests that people with depression become trapped in a cycle of negative thoughts. They selectively attend to the negative aspects of a situation.
The cycle is negative views about the world, negative views about the future, negative views about oneself.
How do negative schema relate to Beck’s negative triad?
These stem from negative schemas - a self schema is the pack of ideas we have about yourself. An ineptness schema is an expectation of failure and a self blame schema is taking responsibility for all misfortunes.
What are cognitive biases in terms of Beck’s negative triad?
Arbitrary interference - conclusions drawn without sufficient evidence.
Minimisation - minimising any positive events
This can potentially lead to depression.
What did Ellis propose depression was caused from?
Ellis proposed that depression was mainly an event of irrational thoughts about external events.
What is Beck’s ABC model?
He proposed that an activation event caused irrational thoughts, which led to irrational emotions and thoughts, which led to the undesirable behaviour. The beliefs are a crucial difference between individuals who become depressed and those who do not.
What are examples of irrational beliefs in terms of Ellis’s ABC model?
An example of irrational beliefs are: I must always achieve perfection, I must be loved by everyone, and I must achieve in order to be worthwhile.
Does the cognitive approach to treating depression have practical applications?
Beck and Ellis form the basis of CBT for depression where negative beliefs are challenged.
High success rates of CBT validates this.
Is the cognitive approach to depression incomplete?
Does not fully outline the steps and processes of how the sufferer came to think like this.
Although negative thoughts are a symptom of depression, how did they arise in the first place?
Is there supporting research for the cognitive explanation for depression?
Temple Wisconsin studied uni students, none of which were suffering from depression, and assessed them every few months for two years.
17% of those with high scores on negative thinking went on to experience a period of depression compared to 1% of those with low scores.
Does the cognitive explanation of depression account for other aspects?
Takes into account aspects such as genes and environment.
Beck and Ellis both suggest that the environment contributes to negative thinking.
Ellis comments on activating events and Beck suggests thoughts are affected by rejection in childhood.
Are there theoretical weaknesses of the cognitive explanation of depression?
Some psychologists believe faulty thinking is a symptom of depression not the cause.
Depressed people have negative thoughts, but are these side effects or causes?
It could be due to chemical imbalances in the brain.
What are the general principles of CBT for depression?
CBT tackles both cognition and behaviour by making patients aware of the relationship between thought, emotion, and action
What is meant by an umbrella term?
Used to cover a number of functions that fall under a common category
What is the aim of CBT?
The aim of CBT is to help rationalise and challenge depressed patients’ irrational thinking
What are the steps of CBT for depression?
Identifying negative thinking patterns
Challenging irrational thoughts
Skill acquisition and application
Follow up
What is identifying negative thinking patterns for CBT?
patients should talk about specific difficulties they experience and identify any negative automatic thoughts and set goals.
What is challenging irrational thoughts in CBT for depression?
challenge irrational thoughts and present alternatives.
What is skill acquisition and application in CBT for depression?
work on a patient with intervention techniques including new ways of thinking about things, such as relaxation techniques and optimistic self-statements.
What is the follow up in CBT for depression?
Final assessment using self-reports and comparing the before and after.
Is there research to support CBT for depression?
March et al - compared 327 adolescents receiving only CBT, only antidepressants or a combination of both.
After 36 weeks, 86% of those using CBT and antidepressants had improved compared to 81% of other groups.
Does CBT for depression fall under the aetiological fallacy?
The cause may not be cognitive just because cognitive treatments are successful.
Just because some symptoms are removed, does not mean the origin of depression has been addressed.
Does CBT for depression deal with the root cause?
Improves the chance of a short depressive episode and reduces chance of relapse.
This could be due to the skill acquisition of CBT.
Does CBT for depression rely too much on the therapist?
The quality of this relationship determines improvement.
Luborsky found that there were very little differences between therapies.
Does CBT work for people with severe depression?
CBT seems to be most effective for those who have a high degree of insight into their condition.
This may be because you need to mentally engage with the process of disrupting faulty thinking.
What does the genetic explanation of OCD suggest about relatives?
Genetic research has found that first degree relatives of people with OCD have a greater vulnerability of developing the disorder. Nestadt et al (2000) found that first degree relatives had a 12% chance of developing the disorder compared to a 3% risk in the general population.
What are candidate genes in terms of the genetic explanation of OCD?
These genes are involved in regulating the production of the neurotransmitter serotonin that is also implicated in OCD.
What are the candidate genes in terms of the genetic explanation of OCD?
SERT and COMT
What is the SERT gene in terms of the genetic explanation of OCD?
If this is impaired, it leads to problems with the transport of the neurotransmitter serotonin. This ultimately leads to diminished levels of serotonin, which correlates with OCD.
What research is there for the SERT gene?
In one study, a mutation of this gene was found in two unrelated families where 6 out of 7 members had OCD - Ozaki
What is the COMT gene in terms of the genetic explanation of OCD?
In short, this gene regulates the production of another neurotransmitter called dopamine. An impaired COMT gene leaves too much dopamine in the synapse, resulting in some of the compulsive behaviours seen in patients of OCD.
What research is there for the COMT gene?
Taylor (2013) has identified up to 230 candidate genes that may contribute to OCD, which ultimately suggests OCD is polygenic.
Is there supporting research for the genetic explanation of OCD?
Nestadt’s review of twin studies found a concordance rate for OCD of 67% for identical twins but only 31% for fraternal twins.
The closer the genetic relationship to the sufferer, the greater the risk of developing OCD.
Is the genetic explanation of OCD theoretically flawed?
Genes cannot be the only reason, or the concordance rate of identical twins would be 100%.
There must be environmental influences, like the imitation of role models.
Is the genetic explanation of OCD scientific?
Genetics can be studied objectively using DNA analysis.
You could also trace back family history to find concordance rates.
Is the genetic explanation for OCD biologically reductionist?
It ignores the role of early childhood trauma, or that obsessions and compulsions can be learnt via observation of parents.
What are the factors of the neural explanation for OCD?
The role of the damaged cordate nucleus and the orbitofrontal cortex
The role of low serotonin
The role of high dopamine
How does the role of the damaged cordate nucleus and orbitofrontal cortex contribute to the neural explanation of OCD?
Several areas of the frontal lobes of the brain are thought to be abnormal in people with OCD. The caudate nucleus normally suppresses signals from the orbitofrontal cortex. In turn, the OFC sends signals to the thalamus about things that are worrying, such as a potential germ hazard. When the caudate nucleus is damaged, it fails to suppress minor worry signals and the thalamus is alerted, which in turn sends signals back to the OFC, acting as a worry circuit.
How does the role of low serotonin contribute to the neural explanation of OCD?
Serotonin plays a role in preventing behaviour repetition and therefore low levels of this neurotransmitter may be linked to the compulsions that can be displayed as a symptom of OCD.
How does the role of high dopamine contribute to the neural explanation of OCD?
Dopamine creates anticipation for rewards, this is known as the dopaminergic reward system. The continuous activation of the ventral striatum creates an undirected expectation for reward. This unfulfilled expectation causes an anxious feeling and an urge to satisfy the void. As a result, learned rituals are practised to generate this reward, however, the reward is likely to do little and the ritual needs to be repeated.
Is there supporting research for the neural explanation of OCD?
Ursu and Carter monitored brain activity in 15 OCD patients using fMRI scans.
There was hyperactivity in the orbitofrontal cortex, which has been linked to OCD.
Are there theoretical flaws of the neural explanation of OCD?
There could be other variables, not just brain abnormalities, and we cannot be sure what has an impact.
It could be OCD that causes the changes in brain abnormality, not the brain abnormality causing OCD.
Does the neural explanation of OCD have practical applications?
Helped the 2-3% of society that suffers from OCD.
Antidepressant drugs like Proxac and valium work by changing the neurochemical balance in the brain.
Symptoms of OCD can be relieved by adjusting the chemical signals.
Is the neural explanation of OCD scientific?
Neurotransmitters are scientifically tested in the body using urine tests for ones associated with OCD.
Objective way to prove the neurochemical levels are linked to symptoms of OCD.
What is the basics of drug therapy for treating OCD?
When neurotransmitters are released into the synapse gap, not all of it attaches to the receptor sites on the receiving neuron. The remaining neurotransmitters must be removed to allow the synapse to return to its normal state.
How are neurotransmitters removed from the synaptic gap?
Reuptake of the remaining neurotransmitter into the presynaptic neuron
Breakdown of the neurotransmitter into the synaptic cleft by an enzyme
What is the thinking behind using SSRIs to treat OCD?
If low levels of serotonin are a possible causal factor in the development of OCD, then it makes sense for a possible treatment to increase the levels of serotonin.
How is drug therapy used to treat OCD?
SSRI’s - They block the reuptake pump in the synapse. This reduces the rate of reabsorption of serotonin, making it more available in the synapse gap. By blocking the transportation, SSRis keep serotonin floating around the synapse space. Due to this increased availability, some serotonin receptors that are inhibitory reduce in number. This makes each serotonin cell fire rapidly to access more serotonin. This neuroadaptation takes a few weeks to occur but helps alleviate OCD symptoms.
What are other drugs that can be prescribed for OCD?
Some other drugs that can be used to treat OCD are valium, benzodiazepine or beta blockers.
Is there supporting research for the biological approach to treating OCD?
Soomro conducted a meta-analysis of 17 studies examining effectiveness of SSRIs compared to placebos.
70% of patients responded well and the other 30% responded better to other drugs or a combination of drugs and psychological treatments.
Does the biological approach to treating OCD have unwanted side effects?
Indigestion, blurred vision, loss of sex drive.
Some patients may stop taking their medication, reducing the effectiveness.
Is the biological approach to treating OCD cost effective?
Beneficial for healthcare providers as it saves money compared to other psychological therapies.
Drugs are non-disruptive and can be taken until the symptoms subside. Drugs are more likely to be successful for patients who lack motivation.
Is the biological approach to treating OCD a permanent solution?
Symptoms do often improve, they do not completely disappear, so they are only partially successful.
When patients stop taking drugs, symptoms return.
Therefore people end up dependent on the drugs, which can lead to bad side effects and addiction.
Is the biological approach to treating OCD scientific?
We can collect objective data by comparing symptoms before and after the drug treatment.
The mode of action of the drugs can be studied using blood tests, PET scans, and samples of Cerebrospinal fluid.
What are some examples of irrational thoughts under Ellis’ ABC model?
Polarised thinking - Seeing everything in black and white
Over-generalisation - Making sweeping generalisations
Tyranny of ‘must’, ‘ought’ and ‘should’ - stating something must happen
Catastrophizing - making a mountain out of a mole hill
Utopianism - Pursuit of a state which is unrealistically perfect
How can irrational thoughts be challenged in CBT?
Ellis’ REBT model
Beck’s CBT
How does Ellis’ REBT model challenge irrational thoughts?
He called alternatives disputing beliefs which rationalises the patient’s faulty thinking, leading to effective behaviour
This is called cognitive reframing
abcDE
How does Beck’s CBT challenge irrational thinking?
Thought catching - identifying irrational thoughts and their negative triad of the self, the world and the future
Patient as scientist - the patient creates hypotheses to test how irrational their thoughts are. Evidence is presented for and against their negative thoughts
Behavioural activation - patients are set specific tasks to change their behaviour.
