psychopathology Flashcards
what are the four definitions of abnormality?
-statistical infrequency
-deviation from social norms
-failure to function adequately
-deviation from ideal mental health
what is statistical infrequency?
occurs when an individual has less common characteristics.Being below average or above average could be seen as abnormal.
what is an example of statistical infrequency?
IQ and intellectual disability disorder (when IQ is below 70)
Evaluation 1- real world application (statistical infrequency)
-a strength
-can be used in clinical practices, both as part of formal diagnosis and a way to assess the individuals symptoms
-shown in Becks depression inventory where a score of 30+ is widely interpreted as indicating severe depression
-this shows that the value of statistical infrequency criterion is useful in diagnostic and assessment processes
Evaluation 2- unusual characteristics can be positive (statistical infrequency)
-a limitation
-infrequent characteristics can be seen as positive as well as negative
-we do not think of someone as abnormal for having a high IQ
-this shows statistical infrequency can form part of an assessment but is never sufficient as the social basis for defining abnormality
what is deviation from social norms?
concerns behaviour that is different from the accepted standards of behaviour in a community or society
what is an example of deviation from social norms?
-antisocial personality disorder
what is antisocial behaviour?
-being impulsive,aggressive and irresponsible
- associated with failure to conform to lawful and culturally normative ethical behaviour, which is considered abnormal
Evaluation 1- real world application(deviation from social norms)
-a strength
-used in clinical practices and has value in psychiatry
-can play a part in diagnosis of antisocial personality disorder and schizoptypal personality disorder
-this shows that the deviation from social norms criterion has value in psychiatry
Evaluation 2- cultural and situational relativism (deviation from social norms)
-a limitation
-there are different social norms in different cultures and situations
-a person can label someone as abnormal from one culture but another person from another culture can label someone as normal
-for example hearing voices in some cultures can be seen as a gift but would be seen as abnormal in the UK
-so its difficult to judge deviation from social norms
what is failure to function adequately?
occurs when someone is unable to cope with ordinary demands of day-to-day living
when is someone failing to function adequately?
-when a person no longer conforms to standard interpersonal rules e.g. maintaining eye contact
-when experiencing severe personal distress
-when a persons behaviour becomes irrational or dangerous to themselves or others
(proposed by Rosenhan and Seligman)
Evaluation 1- represents a threshold for help(failure to function adequately)
-it represents a sensible threshold for when people need help
-around 25% of people in the UK will experience a mental health problem
-when people cease to function adequately, they seek professional help or referred for help from others
-means that treatments can be targeted to those who need it most
Evaluation 2-discrimination and social control(failure to function adequately)
-a limitation
-it can be hard to say when someone is really failing to function or whether its their choice
-some people with alternatives choose to live off-grid
-means people who make unusual choices are at risk of being labelled abnormal and their freedom of choice may be restricted
what are the three categories of phobias according to the DSM?
-specific phobia
-social anxiety
-agoraphobia
what is specific phobia?
-phobia of an object or body part or a situation
what is social anxiety?
-phobia of social situation such as public speaking or using public toilets
what is agoraphobia?
-phobia of being outside or in a public place
what are the three behavioural characteristics of phobias?
-panic
-avoidance
-endurance
what are the three emotional characteristics of phobias?
-anxiety
-fear
-emotional response is unreasonable
what are the three cognitive characteristics of phobias?
-selective attention to the phobic stimulus
-irrational beliefs
-cognitive distortions
what are the four categories of depression according to the DSM?
-major depressive disorder
-persistent depressive disorder
-disruptive mood dysregulation disorder
-premenstrual dysphoric disorder
what is major depressive disorder?
severe but often short depression
what is persistent depressive disorder?
long term or recurring depression
what is disruptive mood dysregulation disorder?
childhood temper tantrums
what is premenstrual dysphoric disorder?
disruption to mood prior menstruation
what are the three behavioural characteristics of depression?
-activity levels
-disruption t sleep/ eating behaviour
-aggression and self harm
what are the three emotional characteristics of depression?
-lowered mood
-anger
-lowered self esteem
what are the three cognitive characteristics of depression?
-poor concentration
-attending to and dwelling on the negative
-absolutist thinking (all good or all bad)
What are the DSM categories of OCD?
-OCD
-trichotillomania
-hoarding disorder
-excoriation disorder
what is OCD?
-condition characterised by obsessions(recurring thoughts,images)/compulsive behaviour (such as handwashing)
what is trichotillomania?
compulsive hair pulling
what is a hoarding disorder?
gathering of possessions and not being able to part with them
what is an excoriation disorder?
compulsive skin picking
what are the three behavioural characteristics of OCD?
-compulsions are repetitive
-compulsions reduce anxiety
-avoidance
what are the three emotional characteristics of OCD?
-anxiety and distress
-accompanying depression
-guilt and disgust
what are the three cognitive characteristics of OCD?
-obsessive thoughts
-cognitive coping strategies (eg. religious person tormented by guilt would pray)
-insight into excessive anxiety (think of worst case scenarios)
what is the behavioural approach to explaining phobias?
the two process model
what does the two process model consist of?
-acquisition by classical conditioning
-maintenance by operant conditioning
Describe the study that shows acquisition by classical conditioning ?
-albert showed no unusual anxiety at the at the start of the study
-when shown a white rat he tried to play with it
-the experimenters planned to make an unpleasant and loud sound next to Alberts ear whenever the rat appeared
-the noise was UCS and created UCR which was fear
-when the NS (the rat) was combined with a UCS it became associated with it
-rat now became a CS and produces a CR of fear
how does operant conditioning continue a phobia?
-reinforcement tends to increase a behaviour happening
-in this case of negative reinforcement an individual avoids a situation that is unpleasant
-Mowrer suggests whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that we would have experienced if we had remained there
Evaluation 1-real world application (behavioural approach to explaining phobias)
-a strength
-two-process model has an application in exposure therapies
-it is important in explaining why people with phobias benefit from being exposed to the phobic stimulus
-phobia is the avoidance behaviour so when this avoidance is prevented,the phobia is cured
-shows how important the two process model is in treating phobias
Evaluation 2-cognitive aspects of phobias (behavioural approach to explaining phobias)
-a limitation
-process model does not account for cognitive aspects of phobias
-phobias are not simply avoidance responses
-they also have a significant cognitive component e.g. irrational beliefs
-means the two process model does not completely explain the symptoms of phobias as it dos not offer adequate explanation for phobic cognitions
Evaluation 3-phobias and traumatic experiences + counterpoint (behavioural approach to explaining phobias)
-strength
-two process model is evidence for a link between bad experiences and phobias
-study found that 73% of people with a fear of dental treatment had experienced a traumatic experience
-this confirms that the association between stimulus(dentistry) and an UCR (pain) does lead to the development of a phobia
COUNTERPOINT
-not all phobias appear with a bad experience
-common phobias such as snake phobias occur is populations where few people had any experience with snakes
-means associations between phobias and frightening experiences is not as strong
what are the two behavioural approaches to treating phobias?
-systematic desensitisation
-flooding
what are the three processes involved in systematic desensitisation ?
1.anxiety hierarchy- list of situations that involve the phobic stimulus from least to most frightening
2.relaxation- It is impossible to be afraid and relaxed at the same time and so the therapist teaches the patient relaxation techniques such as breathing exercises
3.exposure- Once the patient is comfortable and relaxed in the lower levels of the hierarchy, then they move up the scale and in the last step they are exposed to the phobia
Evaluation 1-evidence of effectiveness (systematic desensitisation)
-a strength
-Gilroy followed up 42 people who had SD for spider phobia in three 45 minute sessions and the SD group was less fearful than the control group treated by relaxation without exposure
-Wechsler et al concluded the SD is effective for specific phobia,social phobia and agoraphobia
-means that SD is likely to be helpful for people with phobias
Evaluation 2-people with learning disabilities (systematic desensitisation)
-strength
-people with learning disabilities often struggle with cognitive therapies that require complex rational thought
-this means that SD is often the most appropriate treatment for people with learning disabilities
How does flooding work?
a person is exposed to an extreme form of phobic stimulus in order to reduce anxiety triggered by that stimulus
is flooding unethical?
Flooding is not unethical yet an unpleasant experience so it is important for clients to give full consent
Evaluation 1- cost effective (flooding)
-strength
-its highly cost effective as its clinically effective and not expensive
-flooding can work as little as one session instead of e.g.10 for SD to achieve the same results
-means more people can be treated with flooding
Evaluation 2-traumatic (flooding)
-limitation
-its a highly unpleasant feeling
-Schumacher et al found that participants and therapists rate flooding as significantly more stress full than SD
-this raises ethical issues for psychologists however it is not a serious issue as they obtain informed consent
-overall therapists may avoid using this treatment
What are the two components of the cognitive approach to explaining depression?
-becks negative triad
-Ellis’s ABC model
what are the three parts that Beck suggested to the cognitive vulnerability?
-faulty information processing(tend to look at the negative not positive )
-negative self-scheme
-negative triad
what is the negative triad composed of?
-negative view of the world
-negative view of the the future
-negative view of self
Evaluation 1- research support (becks negative triad)
-a strength
-in a review Clark and Beck concluded that not only were these cognitive vulnerabilities more common in depressed people but they preceded the depression
-another study by Cohen et al. tracked development of 473 teenagers, regularly measuring cognitive vulnerability. It was found that showing cognitive vulnerability predicted later depression
-this shows there is an association between cognitive vulnerability and depression
Evaluation 2- real world application (becks negative triad)
-a strength
-has applications in screening and treatment for depression
-Cohen et al concluded that assessing cognitive vulnerability allows psychologists to screen young people and monitoring them
-it can also be applied in cognitive behaviour therapy which make people more resilient to negative life event
-means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice
That does the ABC in Ellis’s ABC model stand for and define them?
A-activating event ( we get depressed when we experience negative events which trigger irrational thoughts)
B-beliefs(1. musturbation which is the belief that its a major disaster is things don’t go smoothly 2.utopianism-belief that life is always meant to be fair)
C-consequences (activating event triggers irrational beliefs that are emotional and behavioural consequences)
Evaluation 1- real world application (ABC Model)
-strength
- real world application in psychological treatment of depression
-Ellis’s approach to cognitive therapy is called REBT where the therapist argues with the depressed person which can alter the irrational beliefs that make them unhappy
-this means that REBT has real world values
Evaluation 2- reactive and endogenous depression ( ABC Model)
-limitation
-only explains reactive depression and not endogenous depression
-depression is often triggered by life events which is called reactive depression.
-however, many cases of depression are not traceable to life events and its not obvious what leads a person to that state which is called endogenous depression
-therefore the ABC Model is a partial explanation as it can only explain some cases of depression
what is the cognitive approach to treating depression?
cognitive behaviour therapy
what 2 therapies are a form of cognitive behaviour therapy
-Beck’s cognitive therapy
- Ellis’s rational emotive behaviour therapy ( REBT)
How does Beck’s cognitive therapy work
-people identify their irrational thoughts (from the negative triad)
-Once they have identified their irrational thoughts, CBT helps patients change them
- the patient challenges these thoughts directly and the therapist assists the client in challenging the reality of their irrational thoughts
-Client are often set homework to record positive events, which can be used in the sessions to help them challenge their irrational thoughts
-e.g. the patient may say to the therapist, ‘Everyone hates me’, however, due to the homework completed by the client, they have recorded a social event where they went with close friends and had a good time
How does Ellis’s rational emotive therapy ( REBT) work example
-A client talks to their therapist about the fact that everyone hates them
-REBT would challenge these thoughts and argue with the client, the argument would be a strong argument where they challenge the specific irrational thought
-The therapist intends to break the link between the negative life effects and depression by changing the clients irrational belief
There are different types of arguments identified by Ellis….
-Empirical arguments: Disputing if there is real evidence to support the irrational belief
-Logical arguments: Disputing if the negative thought follows logically from the facts
what is behavioural activation
working with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that improve their moods
evaluation 1- evidence of effectiveness ( cognitive approach to treating depression)
- strength
- evidence supporting its effectiveness for treating depression.
- March et al. compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents.
-After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved.
-So CBT was just as effective when used on its own and more so when used alongside antidepressants.
-CBT is usually a fairly brief therapy requiring six to 12 sessions so it is also cost-effective.
-This means that CBT is widely seen as the first choice of treatment in public health care systems such as the National Health Service.
evaluation 2- suitability for diverse clients ( cognitive approach to treating depression)
-limitation
- lack of effectiveness for severe cases and for clients with learning disabilities.
-In some cases depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT and not even be able to pay attention to what is happening in a session
- complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities.
-Sturmey suggests that, any form of psychotherapy is not suitable for people with learning disabilities and this includes CBT.
-This suggests that CBT may only be appropriate for a specific range of people with depression.
evaluation 3- counterpoint of suitability for diverse clients ( cognitive approach to treating depression)
-there is more recent evidence that challenges CBT not being suitable for people with disabilities or severe cases
- Lewis and Lewis concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression.
- Taylor et al. concluded that when used appropriately, CBT is effective for people with learning disabilities.
-This means that CBT may be suitable for a wider range of people than was once thought.
evaluation 4- relapse rates (cognitive approach to treating depression)
- limitation
- high relapse rates.
-Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last. - Ali et al. assessed depression in 439 clients every month for 12 months following a course of CBT. 42% of the clients relapsed into depression within six months of ending treatment and 53% relapsed within a year.
-This means that CBT may need to be repeated periodically.
what are the two parts of the biological approach to explaining OCD
-genetic explanations
-neural explanations
what are the genetic explanations to OCD
-is a biological explanation
-diathesis-stress model suggests certain genes leave some people more likely to suffer a mental disorder but is not certain-some environmental stress is necessary to trigger the condition.
-Candidate genes create vulnerability for OCD ,some of these genes are involved in regulating the serotonin system.
-OCD is polygenic so has several genes that are involved such as those associated with the action of dopamine and serotonin,both neurotransmitters that are believed to regulate mood.
-There are different types of OCD based on different groups of genes.
evaluation 1- research support ( genetic explanations to explaining OCD)
-strength
-strong evidence base.
- sources strongly suggests that some people are vulnerable to OCD as a result of their genetic make-up.
- Nestadt et al. reviewed twin studies and found that 68% of identical twins (MZ) shared OCD as opposed to 31% of non-identical (DZ) twins.
-Research has found that a person with a family member diagnosed with OCD is around four times as likely to develop it as someone without (Marini and Stebnicki ).
-These research studies suggest that there must be some genetic influence on the development of OCD.
evaluation 2- environmental risk factors ( genetic explanations to explaining OCD)
- limitation
- there are environmental risk factors.
- OCD does not appear to be entirely genetic in origin and it seems that environmental risk factors can also trigger or increase the risk of developing OCD.
- Cromer et al. found that over half the OCD clients in their sample had experienced a traumatic event in their past. OCD was also more severe in those with one or more traumas.
-This means that genetic vulnerability only provides a partial explanation for OCD.
neurological explanations to OCD - the role of serotonin
-serotonin regulates mood and is a neurotransmitter.
-Low levels of serotonin means that the normal transmission of mood-relevant information does not take place,so mood is affected.
-Some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain.
neurological explanations to OCD - decision making systems
-Some cases of OCD seem to be associated with impaired decision making due to abnormal functioning of the frontal lobes of the brain.
-The frontal lobes are responsible for logical thinking and making decisions.
-There is evidence that suggests that the left parahippocampal gyrus associated with processing unpleasant emotions,functions abnormally in OCD.
evaluation 1- research support ( neural explanations to explaining OCD)
- strength
- existence of some supporting evidence.
-Antidepressants that work purely on serotonin are effective in reducing OCD symptoms and this suggests that serotonin may be involved in OCD.
-OCD symptoms form part of conditions that are known to be biological in origin, such as Parkinson’s disease, which causes muscle tremors and paralysis (Nestadt et al. 2010). - If a biological disorder produces OCD symptoms, then we may assume the biological processes underlie OCD.
-This suggests that biological factors may also be responsible for OCD.
evaluation 2- no unique neural system ( neural explanations to explaining OCD)
- limitation
- serotonin-OCD link may not be unique to OCD.
-Many people with OCD also experience clinical depression. This depression probably involves disruption to the action of serotonin.
-This leaves us with a logical problem when it comes to serotonin as a possible basis for OCD. - It could simply be that serotonin activity is disrupted in many people with OCD because they are depressed as well.
-This means that serotonin may not be relevant to OCD symptoms.
what is the biological approach to treating OCD
drug therapy
what is meant by drug therapy
-Treatment involving drugs, i.e. chemicals that have a particular effect on the functioning of the brain or some other body system.
- In the case of psychological disorders such drugs usually affect neurotransmitter levels.
what are SSRIs
-antidepressant drugs called selective serotonin reuptake inhibitor
-SSRIs work on the serotonin system in the brain.
SSRIs and prevention of reabsorption and breakdown of serotonin
-Serotonin is released by the presynaptic neurons and travels across a synapse
- The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and reused.
-By preventing the reabsorption and breakdown, SSRIs effectively increase levels of serotonin in the synapse and thus continue to stimulate the postsynaptic neuron.
-This compensates for whatever is wrong with the serotonin system in OCD.
Combining SSRls with other treatments
-Drugs are often used alongside CBT to treat OCD.
-The drugs reduce a person’s emotional symptoms, such as feeling anxious or depressed.
-This means that people with OCD can engage more effectively with the CBT.
- some people respond best to CBT alone whilst others benefit more when additionally using drugs like fluoxetine. Occasionally other drugs are prescribed alongside SSRIs.
what are the 2 alternatives to SSRIs
-tricyclics
-SNRIs
tricyclics
-This acts on various systems including the serotonin system where it has the same effect as SSRIs.
-Clomipramine has more severe side-effects than SSRIs so it is generally kept in reserve for people who do not respond to SSRIs.
SNRIs
-SNRIs have more recently been used to treat OCD.
-These are a different class of antidepressant drugs and are a second line of defence for people who don’t respond to SSRIs.
-SNRIs increase levels of serotonin as well as another different neurotransmitter - noradrenaline,
evaluation 1- evidence of effectiveness (biological approach to treating OCD)
-strength
-There is clear evidence to show that SSRls reduce symptom severity and improve the quality of life for people with OCD.
-Soomro et al reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD. All 17 studies showed significantly better outcomes for SSRIs than for the placebo conditions.
-Typically symptoms reduce for around 70% of people taking SSRIs.
-This means that drugs appear to be helpful for most people with OCD.
evaluation 2- counterpoint of evidence of effectiveness (biological approach to treating OCD)
-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.
-Skapinakis et al carried out a systematic review of outcome studies and concluded that both cognitive and behavioural therapies were more effective than SSRIs in the treatment of OCD
-This means that drugs may not be the optimum treatment for OCD.
evaluation 3- cost effective and non disruptive (biological approach to treating OCD)
-strength
-they are cheap compared to psychological treatments because many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy.
-Using drugs to treat OCD is therefore good value for public health systems like the NHS and represents a good use of limited funds.
-compared to psychological therapies, SSRIs are also non-disruptive to people’s lives.
-If you wish you can simply take drugs until your symptoms decline whereas psychological therapy involves time spent attending therapy sessions.
-This means that drugs are popular with many people with OCD and their doctors.
evaluation 4- serious side effects (biological approach to treating OCD)
-limitation
-drugs can have potentially serious side-effects.
-Some people 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 e.g. more than 1 in 10 people experience erection problems and weight gain, 1 in 100 become aggressive and experience heart-related problems.
-This means that some people have a reduced quality of life as a result of taking drugs
