Psychopathology Flashcards
Critically discuss one or more definitions of abnormality. (AO1)
The term abnormality refers to when someone behaves in a way that would not be defined as normal.
Statistical infrequency defines abnormality in terms of behaviours seen as statistically rare or which deviate from the mean average or norm. A normal distribution curve can be generated from data which demonstrates which behaviours people share in common. Most people will be on or near the mean average however individuals which fall outside this “normal distribution” and two standard deviation points away are defined as abnormal.
The majority of normal behaviours cluster in the middle of the distribution graph with abnormal characteristics around the edges or tails making them statistically rare and therefore a deviation from statistical norms.
Deviation from social norms defines abnormality in terms of not sticking to expected behaviours within society in certain situations. Within society there are unwritten standards of acceptable behaviour which are set by the social group and everyone within this social group is expected to follow these behaviours. Such behaviours form an important glue for society as they usually address fundamental needs. For example, queuing at a bus stop without pushing in is one such norm that has no written law for it but is defined by society as acceptable behaviour. When someone “deviates” from these socially accepted behaviours, by this definition they may be classed as abnormal.
Defining abnormality on the basis of failure to function adequately takes to account a persons ability to cope with the daily demands of life. Most adults need to wake up and work to earn an income as well as maintain themselves, cleaning themselves, their home, paying bills and meet their responsibilities and relationships with others.
When someone’s behaviour suggests they are unable to meet these demands then they may be diagnosed as abnormal. People who fail to function adequately may be unpredictable, showcase maladaptive behaviour and cause themselves as well as others distress.
Deviation from ideal mental health assesses abnormality by looking for signs that suggest there is an absence of wellbeing and deviation away from normal functioning would be classed as abnormal. Jahoda (1958) provides a set of characteristics which are defined as normal and deviation from these traits would define a person as abnormal. This definition deems anyone who has low self-esteem, doesn’t self-actualise, isn’t autonomous, is vulnerable to stress, doesn’t have mastery of their environment or an accurate perception of reality abnormal.
Critically discuss one or more definitions of abnormality. (AO3)
- Deviation from social norms= low temporal validity: One major issue with basing abnormal behaviour on a set of social norms is that they are subject to change over time. Behaviour that is socially acceptable now may suddenly be seen as socially deviant later and vice versa. Today homosexuality is seen as socially acceptable however based on this definition it was seen as socially deviant and classed as a mental disorder in the past. Therefore this definition is very era-dependent. This means that this definition cannot be applied in a universal or permanent manner. This means that it can be difficult to use.
- Failure to function doesn’t take into account an individual’s circumstances: Individuals experiencing anxiety and distress for religious met reason, for example, exams and bereavement may fail to function adequately for awhile. Sometimes it is normal to fail to function. This is a weakness because their behaviour could be identified as abnormal by this definition however its an entirely normal response to difficult circumstances.
- Ideal mental health= culturally biased: This definition would be culturally biased as these set of ideals put forth by Jahoda are based on western ideals of what ideal health looks like. If this used to judge the behaviour of people from different cultures, then this may provide an incorrect diagnosis of abnormality. For example, collectivist cultures focus on communal goals rather than personal autonomy and such criteria would be ill-suited for diagnosing abnormality in such cultures. This is likely true for people from different socio-economic backgrounds too as people of poorer backgrounds may be found to struggle more with achieving these ideal criteria than someone who has vast resources and support. This is a limitation as it may not be possible for us to use this definition in non-Western cultures
Outline and evaluate the behavioural approach to explaining phobias. (AO1)
The behavioural approach suggests that so be as like all behaviours are learned, an individual learns to fear certain objects or situations through the interactions and experiences they encounter. The two process model explains how a phobia begins and then how the phobia is maintained.
A phobia develops through a process called classical conditioning which involves learning through association. When developing a phobia, we learn to associate something with which we initially had no fear (NS), with something that already triggers a fear response (UCS), from a reflex response. For example, if an individual chokes when they are swimming, they might associate the choking with water. Their response to choking (fear and panic) may transfer to water in the future. They will respond to water with fear and thus a phobia is formed.
A phobia is maintained through the process of operant conditioning, which is learning through consequences. The likelihood of the behaviour being repeated depends on the consequences that follow. If a behaviour is followed by reward it is likely to be repeated. For example, an individual with a phobia of water avoids being in or around water and this is followed by a reduction in their fear and anxiety (avoids an unpleasant feeling). This is negative reinforcement and makes them more likely to continue avoiding water.
Outline and evaluate the behavioural approach to explaining phobias. (AO3)
+ Supporting evidence: Watson and Rayner conducted a study to see whether classical conditioning can cause phobias. They presented a baby (Little Albert) with a white rat (neutral stimulus). Before conditioning, Albert played happily with it and showed no signs of fear. Whilst he was playing with the rat, a loud noise (unconditioned stimulus) scared which produced the fear response (unconditioned response). The fear that he felt from the loud noise became associated with the white rat, and Albert developed a phobia of white rats and anything white and furry. This is a strength, as we can be more confident that the behavioural approach offers an accurate explanation for how and why phobias develop.
- Challenging evidence: Not all research supports the idea that we must have experienced an unpleasant event with the phobic object. For example, Munjack (1984) found that only 50% of people with driving phobia had frightening experience in a car. This shows that we do not have to experience the phobic object. This is a weakness because these instances cannot be explained by conditioning and we lose confidence in the claims of the behavioural explanation of phobias.
+ Practical applications: This approach to explaining phobias has led to the development of successful behavioural therapies. Both systematic desensitisation and flooding are based on the principles of classical conditioning, and research has shown that they are effective at treating phobias through counter conditioning. This is a strength because the behavioural approach offers a solution to the problem and it helps people in the real world. This has a strong positive impact upon the economy by helping people stay in work while they are undergoing treatment and minimising the amount of sickness payment required within society.
Outline and evaluate the behavioural approach to treating phobias. (AO1)
The behavioural approach in the treatment of phobias focuses on systematic desensitisation and flooding.
They are both based on the assumption that if phobias are a learned response as classical and operant conditioning suggests, then they can be unlearnt. They are also based on the idea of reciprocal inhibition. This is the notion that we cannot experience two incompatible emotional states at the same time. This means we cannot be frightened and relaxed simultaneously. Both methods can be conducted in vivo (direct exposure) or in vitro (imagination).
Systematic desensitisation teaches patients to replace their fearful feelings through a process of hierarchal stages which gradually introduces the person to their feared situation one step at a time.
Patients are taught relaxation techniques that help manage their anxiety and distress levels to help them cope but also to associate these feelings of calmness towards the phobia. Relaxation techniques taught may help the patient focus on their breathing and taking slower, deeper breaths as anxiety often results in faster, shallow breathing.
The hierarchy is constructed prior to treatment starting from the least feared to most feared situation working towards contact and exposure. Earlier stages may involve pictures of the phobic situation (a picture of a snake for example if this is their fear) which may then lead to the goal of holding one. As patients master each step they move on to the next. This process allows the individual to learn a new association between their feared stimulus and feeling relaxed.
Flooding is an alternative approach to systematic desensitisation and either exposes the patient directly to their phobia or they are asked to imagine an extreme form of it.
The client is also taught and encouraged to use relaxation techniques prior to the exposure to the phobic situation which continues until the patient is able to fully relax.
In fear-based situations, the patient will release adrenaline however this will eventually cease as we can’t maintain a state of high anxiety for a long time. This causes relaxation to be associated with their feared stimulus as they are unable to use their normal avoidance methods. The procedure can be conducted using virtual reality too.
Outline and evaluate the behavioural approach to treating phobias. (AO3)
+ SD= Effective: One strength of systematic desensitisation comes from research evidence which demonstrates the effectiveness of this treatment for phobias.
McGrath et al. (1990) found that 75% of patients with phobias were successfully treated using systematic desensitisation, when using in vivo techniques (see below). This shows that systematic desensitisation is effective in treating phobias.
Further support comes from Gilroy et al. (2002) who examined 42 patients with arachnophobia (fear of spiders). Each patient was treated using three 45-minute systematic desensitisation sessions. When examined three months and 33 months later, the systematic desensitisation group were less fearful than a control group (who were only taught relaxation techniques). This provides further support for systematic desensitisation, as a long-term treatment for phobias.
- flooding not always appropriate: A weakness is that the therapy is not always an appropriate method of treatment. This is because flooding deliberately creates high levels of anxiety, so as a traumatic experience for phobic patients. This raises ethical issues concerning acceptable levels of suffering by patients and means they may drop out the treatment. This treatment is not appropriate for children or people with heart problems due to the high anxiety levels it causes. This is a weakness because the therapy will not be successful for all individuals with a phobia and may be inaccessible for others.
- Not all aspects of the therapies are equally effective: Systematic desensitisation and flooding conducted in vitro is less effective than confronting the actual examples of the feared stimulus. The extent to which any individual has a vivid imagination sufficient to represent their fear is questionable, and better results have been attained when using in vivo techniques. This is a weakness because the therapies may not be effective for all individuals as some may have phobias where it is not possible to confront actual examples of the feared stimulus.
Outline and evaluate the cognitive approach to explaining depression. (AO1)
Depression is a mental disorder characterised by low mood and low energy levels. The cognitive approach suggests that irrationally negative thinking is the cause of depression.
According to Ellis, depression is the result of irrational thinking, which prevents us from being happy and pain free.
Ellis proposed the A-B-C three stage model, to explain how irrational thoughts could lead to depression.
A: Activating Event occurs. For example, you pass a friend in the corridor at school and he/she ignores you, despite the fact you said ‘hello’.
Your belief is your interpretation of the event, which can either be rational or irrational. An irrational interpretation of the event might be that you think your friend dislikes you and never wants to talk to you again.
According to Ellis, irrational beliefs lead to unhealthy emotional outcomes, including depression (for example, I will ignore my friend and delete their mobile number, as they clearly don’t want to talk to me).
Irrational thinking or interpretations lead to unhealthy outcomes, for example depression, whereas rational and logical thoughts lead to good mental health and happiness.
Beck developed a cognitive explanation of depression which has three components: cognitive bias, negative self-schemas and the negative triad.
Beck found that depressed people are more likely to focus on the negative aspects of a situation, while ignoring the positives. They are prone to distorting and misinterpreting information, a process known as cognitive bias. Beck detailed numerous cognitive biases, two of which include: over-generalisations and catastrophising. Over-generalisations are sweeping conclusions based on a single incident, for example: ‘I’ve failed one end of unit test and therefore I’m going to fail ALL of my exams!’ Alternatively, a depressed person may experience catastrophising, where they exaggerate a minor setback and believe that it’s a complete disaster, for example: ‘I’ve failed one end of unit test and therefore I am never going to study at University.’
A schema is a ‘package’ of knowledge, which stores information and ideas about our self and the world around us. Depressed people possess negative self-schemas, which may come from negative experiences, for example criticism, from parents, peers or even teachers as children.
A person with a negative self-schema is likely to interpret information about themselves in a negative way, which could lead to cognitive biases.
Beck claimed that cognitive biases and negative self-schemas maintain the negative triad, a negative and irrational view of ourselves, our future and the world around us.
Outline and evaluate the cognitive approach to explaining depression. (AO3)
+ Supporting evidence: Researchers assessed pregnant women for cognitive vulnerability and depression before and after giving birth. Cognitive vulnerability is an indicator for negative cognitive biases. They found that those women who judged to be high in cognitive vulnerability were significantly more likely to suffer from post Natal depression. This supports the cognitive approach as it demonstrates a link between distortions in thinking and depression.
- difficult to determine cause and effect between an individual’s thought processes and depression: the cognitive approach does not explain the origins of irrational thoughts and most of the research in this area is correlational. It is not clear whether irrationally negative thinking is the cause of depression or the result of depressive behaviour. For example, a depressed person might not have had negative thoughts before but being depressed might make them interpret events negatively. It is also therefore possible that other factors, for example genes and neurotransmitters, are the cause of depression and one of the side effects of depression are negative, irrational thoughts. This is a weakness as the cognitive approach therefore cannot fully explain depression.
+ Practical applications: One strength is that the cognitive approach has generated a successful therapy as a practical application. The cognitive ideas have been used to develop effective treatments for depression, including Cognitive Behavioural Therapy (CBT) which was developed from Ellis’s ABC model. These therapies attempt to identify and challenge negative, irrational thoughts and replace them with more positive, rational thoughts and have been successfully used to treat people with depression. This provides further support to the cognitive explanation of depression as well as helping those with mental disorders and benefitting the economy by allowing these individuals to stay in employment. This is a strength because it is an effective therapy for depression and so it supports the idea that irrationally negative thinking is the cause of this disorder and helps those struggling- the ultimate aim of Psychology.
Outline and evaluate the cognitive approach to treating depression. (AO1)
Cognitive behaviour therapy (CBT) is a type of psychotherapy. It may help you to change unhelpful or unhealthy ways of thinking, feeling and behaving. CBT helps the person to challenge and overcome cognitive biases, and use practical strategies to change or modify their behaviour. The result is more positive feelings, which in turn lead to more positive thoughts and behaviours.
The first main step is identifying irrational thoughts.
The therapist and client identify the client’s faulty cognitions (thoughts, beliefs and feelings) through an initial assessment. This so progress can be tracked.
The second step is to challenge the irrational thoughts.
The therapist tries to help the client see that these cognitions are irrational. This is known as disputing. There are 3 types of disputing. Logical disputing is getting the client to realise that their self-defeating beliefs are not logical. Pragmatic disputing is getting the client to realise that their self-defeating beliefs are not useful. Empirical disputing is getting the client to realise that their self-defeating beliefs are not realistic. Together, they then set goals to think in more positive or adaptive ways, e.g. focusing on things the client has succeeded at and trying to build on them.
The therapist may start to practice some strategies to help the client to change their behaviours so they can integrate back into society. This can be done using role play or behavioural activation. Role play involves the therapist and client practising implementing new ways of thinking together in small steps using made-up scenarios. Behavioural activation involves setting goals to try and engage in behaviours that they used to enjoy like exercise or social activities.
Outline and evaluate the cognitive approach to treating depression. (AO3)
+ CBT=Effective: One strength of cognitive behaviour therapy comes from research evidence which demonstrates its effectiveness in treating depression. Research found that CBT was effective in treating depression. The researchers examined 327 adolescents with a diagnosis of depression and looked at the effectiveness of CBT and antidepressants. After 36 weeks, 80% of the antidepressant group and 80% of the CBT group had significantly improved, demonstrating the effectiveness of CBT in treating depression.
- CBT may not be appropriate for all sufferers: One issue with CBT is that it requires motivation. Patients with severe depression may not engage with CBT, or even attend the sessions and therefore this treatment will be ineffective in treating these patients. Alternate treatments, for example antidepressants, do not require the same level of motivation and maybe more effective in these cases. This poses a problem for CBT, as it cannot be used as the sole treatment for severely depressed patients.
- Effectiveness of CBT depends on quality of the therapist: Another issue into the effectiveness of CBT is down to the skill level of the therapist themselves. CBT is only effective provided the therapist is well skilled and able to form a collaborative relationship with the patient. Not all therapists will always be as enthusiastic or as capable as one another and this may make CBT ineffective for some patients. One study concluded that as much as 15% of the variance in outcome could be attributed to the therapists level of competency. This is a weakness because depending on the therapist, CBT may help some individuals with depression, but others will have less success.
Outline and evaluate the biological approach to explaining OCD. (AO1)
Obsessive Compulsive Disorder (OCD) is a condition characterised either by obsessive thought, compulsive behaviours or both. There are 2 biological explanations for OCD: genetic and neural.
Genetic explanations suggest OCD is inherited and that individuals inherit specific genes which cause OCD
Genetic explanations have focused on identifying particular genes (candidate genes) which are implicated in OCD.
The COMT gene is associated with the production of the COMT enzyme which regulates the neurotransmitter dopamine. 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 without OCD.
A second gene which has been implicated in OCD is the SERT gene. The SERT gene is linked to the neurotransmitter serotonin and affects the transport of the serotonin, causing lower levels of serotonin which is also associated with OCD (and depression).
Neural explanations of OCD focus on neurotransmitters as well as brain structures.
Neural explanations suggest that abnormal levels of neurotransmitters, in particular serotonin and dopamine, are implicated in OCD. Serotonin regulates mood. Lower levels of serotonin disrupts the regulation of other neurotransmitters (like GABA and dopamine). Support for the role of serotonin in OCD comes from research examining anti-depressants, which have found that drugs which increase the level of serotonin are effective in treating patients with OCD.
In addition, the neurotransmitter dopamine has also been implicated in OCD, with higher levels of dopamine being associated with some of the symptoms of OCD, in particular the compulsive behaviours.
Neural explanations also suggest that particular regions of the brain, in particular the basal ganglia and orbitofrontal cortex, are implicated in OCD. Damage to an area of the basal ganglia (the Caudate Nucleus) disrupts the transmission of information about worrying events. The orbitofrontal cortex (OFC) sends signals to the thalamus about worrying things. These are normally supressed by the caudate nucleus (part of the basal ganglia). When the caudate nucleus is damaged it fails to suppress minor worry signals and the thalamus is alerted. This sends signals back to the OFC, acting as a worry circuit.
Outline and evaluate the biological approach to explaining OCD. (AO3)
+/- Supporting evidence for genetic arguments: support for the biological explanation of OCD comes from twin studies which have provided strong evidence for a genetic link. Nestadt et al. (2010) conducted a review of previous twin studies examining OCD. They found that 68% of identical twins and 31% of non-identical twins experience OCD, which suggests a very strong genetic component. However, it is difficult to draw firm conclusions from this research, as twins are generally exposed to the same environmental factors, and the higher monozygotic concordance rate could be explained by the way identical twins are treated in a more similar way than dizygotic twins.
- alternative explanation: A diathesis-stress model may be better suited to explaining OCD as it factors in both genetics and psychological factors such as environmental stressors. This suggests some people may have a genetic vulnerability to develop OCD providing the right environmental triggers cause its onset. This would be a more appropriate explanation as it effectively explains why identical twins may not both share the disorder. It can also successfully account for the high concordance rates between family members too and provide a more holistic explanation for the development of OCD.
+ Practical application of biological explanations: The idea that serotonin is the cause of OCD has led to drug therapy. SSRI’s have been used to treat OCD. These increase the level of serotonin at the synapse. Zohar et al (1996) found that drugs which increase serotonin have been beneficial for up to 60% of patients with OCD. This is a strength because it requires little commitment and motivation from the client and can therefore support the economy and reduce the burden on the NHS.
Outline and evaluate the biological approach to treating OCD. (AO1)
Biological treatments for OCD aim to restore biological imbalances, such as too little serotonin. Drug treatments are based on the assumption that chemical imbalances are the main cause of the problem. Two types of drug are used for the treatment of OCD: anti-depressants and anti-anxiety drugs.
The biological explanation suggests that OCD (and depression) is the result of low levels of the serotonin in the brain. SSRIs (selective serotonin re-uptake inhibitors) are one type of anti-depressant drug. When serotonin is released from the pre-synaptic neuron into the synapse, it travels to the receptor sites on the post-synaptic neuron. Serotonin which is not absorbed into the post-synaptic neuron is reabsorbed into the pre-synaptic neuron. SSRIs increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the sending cell. This increases level of serotonin in the synapse and results in more serotonin being received by the post-synaptic neuron.
Benzodiazepines (BZs) are anti-anxiety drugs, which work by enhancing the action of the neurotransmitter GABA. During synaptic transmission, GABA binds with GABA-A receptors on the post-synaptic neuron. This opens a channel that increases the flow of chloride ions into the post-synaptic neuron, making it more difficult an action potential to fire. BZs also bind to these receptors and thus enhance the effect of GABA. This means that BZs have a general quietening influence on the brain and consequently reduce anxiety, which is experienced as a result of the obsessive thoughts.
Outline and evaluate the biological approach to treating OCD. (AO3)
+ Drug therapy = effective: Soomro et al. (2008) conducted a review of the research examining the effectiveness of SSRIs and found that SSRIs were more effective than placebos in the treatment of OCD, in 17 different trials. This supports the use of biological treatments, especially SSRIs, for OCD.
-Drugs don’t cure OCD: drug treatments are criticised for treating the symptoms of the disorder and not the cause. For example, SSRIs work by increasing the levels of serotonin in the brain and thus reduces anxiety. However, they simply alleviate the symptoms of OCD, it does not treat the underlying cause of OCD. Furthermore, once a patient stops taking the drug, they are prone to relapse, suggesting that psychological treatments may be more effective, as a long-term solution. This is a weakness, as it suggests that drug therapy is not a permanent cure and alone it is not effective enough at treating OCD.
- Side effects: Although evidence suggests that SSRIs are effective in treating OCD, some patients experience mild side effects like indigestion, while other might experience more serious side effects like hallucinations and high blood pressure. BZs are renowned for being highly addictive and can also cause increased aggression and long-term memory impairments. As a result, BZs are usually only prescribed for short-term treatment. Consequently, these side effect diminish the effectiveness of drug treatments, as patients will often stop taking medication if they experience these side effects.
