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Psychopathology Flashcards
Outline statistical deviation
- Behaviours or characteristics that are statistically rare according to a normal distribution curve are considered to be abnormal
- This may include both desirable and undesirable behaviour
Outline deviation from social norms
- Behaviour that violates the accepted rules of society
- Violation of these social patterns is considered abnormal
- These unwritten social rules differ depending on the culture and the generation the person is in
Outline failure to function adequately
- The inability to cope with every day life and hold interpersonal relationships
- Someone may not be functioning adequately if they are unable to maintain basic standards of hygiene and nutrition
- They fail to function due to psychological distress or discomfort
What are the seven abnormal characteristics relating to failure to function adequately?
Suffering
Maladaptive behaviour
Unconventional behaviour
Unpredictability and loss of control
Irrationality
Observer discomfort
Violation of moral and ideal standards
Outline deviation from ideal mental health
Looks at how mental health is assessed by looking for any signs of an absence of well-being, and those that don’t meet the criteria are listed as deviants.
What are Jahoda’s six characteristics that enable an individual to feel happy and behave competently?
Self attitudes -> having high self-esteem, and a strong sense of identity
Personal growth and self actualisation -> the extent to which an individual develops their full capabilities
Integration -> being able to cope with stressful situations
Autonomy -> being independent and self-regulating
Having an accurate perception of reality
Mastery of the environment -> including the ability to love, function at work, and in interpersonal relationships, adjust to new situations and solve problems
Outline cultural relativism relating to definitions of abnormality
Statistical infrequency: behaviours that are rare in one culture may be common in another culture. For example, one symptom of schizophrenia is hearing voices. However, this is common in some cultures were religious leaders have claimed to have heard the voice of God.
Social norms: social norms are bound by culture. Classification system such as the DSM are almost entirely based on social norms of the dominant culture in the west. However, the most recent revision to the DSM acknowledges cultural differences. For example, panic attacks make reference to uncontrollable crying in some cultures while difficulty breathing might be more common in other cultures.
Failure to function: adequate functioning is relative to cultural ideas of how one’s life should be lived. Therefore, this definition is likely to result in different diagnosis when applied to people from different cultures because the standard of one culture is being used to measure another. This might explain why lower class and non-white patients are more often diagnosed with mental disorders.
Ideal mental health: Most, if not all of Jahoda’s criteria are culture bound. If we apply these criteria to people from non-western or even non-middle-class social groups, we will most likely find a higher incidence of abnormality. For example, self actualisation is relevant to members of individualistic cultures, but not collectivist cultures, where individuals strive for the greater good of their community, rather than themselves.
What is cultural relativism?
The view that behaviour cannot be judged properly unless it is viewed in the context of the culture in which it originates
What is the DSM?
DSM stand for diagnostic and statistical manual of mental disorders and is published by the American Psychiatric Association
The DSM classifies mental disorders into major groups, including depressive disorders, anxiety disorders, obsessive compulsive and related disorders, and feeding and eating disorders
What are the behavioural characteristics of phobias?
- Panic
- Avoidance
- Endurance
What are the emotional characteristics of phobias?
- Anxiety/excessive fear
- Realising their emotional responses are unreasonable
What are the cognitive characteristics of phobias?
- Selective attention to the phobic stimulus
- Irrational beliefs
- Cognitive distortions
What are the behavioural characteristics of depression?
- Low activity levels/loss of energy
- Disruption to sleep and eating behaviour
- Aggression and self harm
What are the emotional characteristics of depression?
- Low mood
- Anger
- Low self-esteem
What are the cognitive characteristics of depression?
- Poor concentration/poor memory
- Attending to and dwelling on the negative
- Absolutist/black and white thinking
What are the behavioural characteristics of OCD?
- Compulsions
- Avoidance
What are the emotional characteristics of OCD?
- Anxiety and distress
- Accompanying depression
- Guilt and disgust
What are the cognitive characteristics of OCD?
- Obsessive thoughts
- Cognitive strategies to deal with obsessions
- Insight into excessive anxiety
Behavioural characteristics
Ways in which people act
Emotional characteristics
Ways in which people feel
Cognitive characteristics
Process of thinking - knowing, perceiving, believing
Outline the behavioural approach to explaining phobias
Two-process model:
- Mowrer (1960)
- Phobias are acquired through classical conditioning
- Phobias are developed through fear being associated with a neutral stimulus
- Phobias are then maintained by operant conditioning - reinforcement
What are the three different types of phobias?
Specific phobias
Social anxiety
Agoraphobia
Explain the acquisition of phobias by classical conditioning
Learning by association
- UCS (bitten by dog) triggers fear response (UCR)
- NS (dog)
- NS is associated with UCS
- NS becomes CS producing fear (CR)
Outline Watson and Rayner’s study ‘little Albert’
- They used a baby boy, referred to as little Albert, who at nine months showed no fear of a white rat
- At 11 months, they carried out the following procedure:
every time the rat was placed in Albert’s lap, Watson made a loud noise by banging together two steel bars behind Albert’s back - Watson did this seven times
- In this procedure, the loud noise is an unconditioned stimulus, and Albert’s response (crying and fear) is an unconditioned response
- Before conditioning, the rat was a neutral stimulus
- By the third trial, Albert showed fear whenever he saw the rat
- The rat was now a conditioned stimulus, and Alberts fear was a conditioned response.
Outline generalisation of phobias
Little Albert also showed a fear response to other white furry objects, such as a fur coat and a Santa Claus mask with a white beard
Explain the maintenance of phobias through operant conditioning
- When an individual avoids a situation that is unpleasant, this behaviour results in a desirable consequence
- Whenever we avoid a phobic stimulus, we successfully escape the fear and anxiety that we would have suffered if we had remained there
- This reduction in fear reinforces the avoidant behaviour and so the phobia is maintained
- This is negative reinforcement
Why are some phobias more common than others?
Seligman suggested that phobias, such as phobia of snakes or spiders or the dark, may be due to evolution. The name of this theory is that these phobias are adaptive/biological preparedness. This theory is supported by Ost and Hughah who claim nearly half of phobics haven’t had an anxious/traumatic experience with the object of their fear. This suggests dangerous phobias may be passed down.
Explain how systematic desensitisation works
Systematic desensitisation is a behavioural therapy design to gradually reduce phobic anxiety through the process of classical conditioning. If the sufferer can learn to relax in the presence of the phobic stimulus, they will be cured. Essentially, a new response to the phobic stimulus is learned, and this is called counterconditioning. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is called reciprocal inhibition. There are three processes involved in systematic desensitisation, which are the anxiety hierarchy, relaxation, and exposure.
The anxiety hierarchy is put together by the patient and the therapist. This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order of least to most frightening.
The therapist teaches the patient to relax as deeply as possible. This might involve breathing techniques, or alternatively the patient might learn mental imagery techniques. Alternatively, relaxation can be achieved using antianxiety drugs such as Valium.
Finally, the patient is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions starting at the bottom of the anxiety hierarchy. When the patient can stay relaxed in the presence of the lower levels of the phobic stimulus, they move up the hierarchy. Treatment is successful when the patient can stay relaxed in situations high on the anxiety hierarchy.
Explain how flooding works
Flooding involves exposing phobic patients to the phobic stimulus but instead of a gradual buildup it involves immediate exposure to a very frightening situation. Flooding sessions are typically longer than a systematic desensitisation session with one session often lasting 2 to 3 hours. Sometimes only one long session is needed to cure a phobia.
Flooding stops phobic responses very quickly. This may be because without the option of avoidant behaviour, the patient quickly learns that the phobic stimulus is harmless. In classical conditioning terms this process is called extinction. A learned response is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus . The result is that the conditioned stimulus no longer produces the conditioned response. In some cases, the patient may achieve relaxation in the presence of the phobic stimulus, simply because they become exhausted by their own fear response.
Flooding is a very unpleasant experience, so it is important that patients give fully informed consent to this traumatic procedure.
List some obsessive compulsive disorders
Trichotillomania
Hoarding disorder
Excoriation disorder
Outline the biological approach to explaining OCD - genetic explanations
- The genetic explanation suggests OCD is inherited through genetic transmission
- Genetic influences are researched by twin and family studies to assess concordance rates in the disorder
- It is unlikely that a single gene causes OCD, more that it is a combination of genes (polygenetic) that determines an individual’s level of vulnerability to develop the disorder
- Lewis observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD, suggesting that OCD runs in families
- According to the diathesis-stress model, certain genes leave some people more likely to develop a mental disorder, but it is not certain -> some environmental stress is necessary to trigger the condition
Candidate genes:
- Researchers have identified certain genes that create vulnerability for OCD called candidate genes.
- Some of these genes are involved in regulating the development of the serotonin system.
- Some examples are the COMT and SERT genes.
Polygenetic:
- OCD is not caused by a single gene buy by a combination of genetic variations that together significantly increase vulnerability
- Taylor analysed findings of previous studies and found that up to 230 genes may be involved in OCD
- Genes that have been studied in relation to OCD include those associated with the action of dopamine as well as serotonin, and both neurotransmitters are believed to have had a role in regulating mood
Different types of OCD:
- Different groups of genes may result in different types of OCD
- The term used to describe this is aetiologically heterogeneous, meaning that the origin (aetiology) of OCD has different causes (heterogeneous)
- There is also some evidence to suggest that different types of OCD may be the result of particular genetic variations, such as hoarding disorder and trichotillomania
Outline the biological approach to explaining OCD - neural explanations
The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures in the brain.
The role of serotonin:
- Serotonin is believed to help regulate mood
- Neurotransmitters are responsible for relaying information from one neuron to another
- If a person has low levels of serotonin, normal transmission of mood relevant information does not take place and mood, and sometimes other mental processes, are affected
- At least some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain
Decision-making systems:
- Some cases of OCD, and in particular hoarding disorder, seem to be associated with impaired decision-making
- This in turn may be associated with abnormal functioning of the lateral bits of the frontal lobes of your brain
- The frontal lobes are the front part of your brain that are responsible for logical thinking and making decisions
- There is also evidence to suggest that an area called the left parahippocampal gyrus, associated with processing unpleasant emotions, functions abnormally in OCD
Outline the biological approach to treating OCD - drug therapy
Drug therapy for mental disorders aims to increase or decrease levels of neurotransmitters in the brain or to increase/decrease the activity.
SSRIs:
- The standard medical treatment used to tackle the symptoms of OCD involves a particular type of antidepressant drug called a selective serotonin reuptake inhibitor
- SSRIs work on the serotonin system in the brain
- Serotonin is released by certain neurons in the brain
- It is released by the presynaptic neurons and travels across a synapse
- The neurotransmitter chemically converts 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 of serotonin, SSRIs effectively increase its levels in the synapse, and thus continue to stimulate the postsynaptic neuron
- This compensates for whatever is wrong with the serotonin system in OCD
Combining SSRIs with other treatments:
- Drugs are often used alongside cognitive behavioural therapy to treat OCD
- Drugs reduce a patient’s emotional symptoms, meaning patients can engage more effectively with the CBT
- In practice, some people respond best CBT alone, while others benefit more from drugs
Alternatives to SSRIs:
- When an SSRI is not effective after 3-4 months, the dose can be increased or it can be combined with other drugs
- People respond very differently to different drugs, and alternatives work well for some people and not at all for others
Tricyclics -> an older type of antidepressant which acts on various systems, including the serotonin system where it has the same effect as SSRIs. Tricyclics often have more severe side effects than SSRIs, so are generally used for people who don’t respond to other drugs
SNRIs -> serotonin-noradrenaline reuptake inhibitors have more recently been used to treat OCD. These are a different class of drugs, and like tricyclics, they are a second line of defence for people who don’t respond to SSRIs. SNRIs increase levels of serotonin and noradrenaline
List four depressive disorders
Major depressive disorder
Persistent depressive disorder
Disruptive mood dysregulation disorder
Premenstrual dysphoric disorder
Outline the cognitive approach to explaining depression - Beck’s negative triad
Beck suggested a cognitive approach to explaining why some people are more vulnerable to depression than others. In particular, it’s a persons cognition that create this vulnerability, i.e. the way they think. Beck suggested three parts to this cognitive vulnerability.
Faulty information processing:
- When depressed, we attend to the negative aspects of a situation and ignore positives
- We also tend to blow small problems out of proportion and think in black and white terms
Negative self schemas:
- Schemas are a package of ideas and information developed through experience
- They act as a mental framework for the interpretation of sensory information
- A self schema is the package of information we have about ourselves
- We use schemas to interpret the world so if we have a negative self schema, we interpret all information about ourselves in a negative way
The negative triad:
- A person develops a dysfunctional view of themselves because of three types of negative thinking that occur automatically, regardless of the reality and what is happening at the time
- These 3 elements are called the negative triad:
-> Negative view of the world -this creates the impression that there is no hope anywhere
-> Negative view of the future -such thoughts reduce any hopefulness and enhance depression
-> Negative view of the self - such thoughts enhance any existing depressive feelings because they confirm existing emotions of low self-esteem
What are the three components of the negative triad?
Negative view of the world
Negative view of the future
Negative view of the self
What are the three components of Beck’s cognitive approach to explaining depression?
Cognitive bias/faulty information processing
Negative self schemas
The negative triad
Outline the cognitive approach to explaining depression - Ellis’s ABC model
Ellis proposed that good mental health is the result of rational thinking. To Ellis, conditions like anxiety and depression result from irrational thoughts. Ellis defined irrational thoughts, not as illogical or unrealistic thoughts, but any thoughts that interfere with us being happy and free of pain.
A - activating event
We get depressed when we experience negative events and these trigger irrational beliefs
B - beliefs
Irrational beliefs
C - consequences
When an activating event triggers irrational beliefs, there are emotional and behavioural consequences, such as depression
Outline CBT as a treatment for depression - Beck
Cognitive behavioural therapy is the most commonly used psychological treatment for depression and a range of other mental health problems.
Cognitive element:
- CBT begins with an assessment in which the patient and the cognitive behavioural therapist work together to clarify the patients problems
- They jointly identify goals for the therapy and put together a plan to achieve them
- One of the central tasks is to identify where there might be negative or irrational thought that would benefit from challenge
Behavioural element:
- CBT then involves working to change negative, maladaptive and irrational thoughts, and put more effective behaviours into place
- Cognitive therapy is the application of Beck’s cognitive theory of depression.
- The idea behind cognitive therapy is to identify automatic thoughts about the world, the self and the future.
- Once identified, these thoughts must be challenged which is the central component of the therapy.
CBT is an umbrella term for a number of different therapies, such as REBT
Outline the structure of CBT
- Begins with an assessment, where the client and therapist work together to set goals and clarify problems
- Aims to identify automatic thoughts about the world, future, and self (thought catching)
- Once identified, these thoughts are challenged, and the client gains reality of their negative beliefs. Cognitive restructuring occurs there negative thoughts are replaced with accurate positive ones
- Homework may be set to record and enjoyable event or a time when people were nice to them. This is referred to as the ‘patient scientist’ as they are investigating the reality of their negative beliefs the way a scientist would. In future sessions, the therapist can produce this evidence to challenge further irrational/negative thoughts
Outline CBT as a treatment for depression - Ellis’s rational emotive behaviour therapy (REBT)
REBT extends the ABC model to an ABCDEF model
D - dispute - challenge the thoughts
E - effect - see a more beneficial effect on thought and behaviour
F - feelings - new positive emotions produced
Ellis argued that irrational thoughts are the main cause of all types of emotional distress and behavioural disorders
REBT challenges the client to prove these irrational statements and beliefs, and then replace them with more reasonable realistic statements using:
- empirical arguments
- logical arguments
- pragmatic arguments
What is behavioural activation?
- as individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms
- alongside the purely cognitive aspects of CBT, the therapist may also work to encourage a depressed patient to be more active and engage in enjoyable activities
- this behavioural activation will provide more evidence for the irrational nature of beliefs
Outline Newark et al’s study on depression
Aim: they wanted to discover if people with psychological problems had irrational attitudes
Method: two groups of participants were asked if they agreed with the following statements identified by Ellis as irrational
- It is essential that one be loved or approved of by virtually everyone in the community (A)
- One must be perfectly competent, adequate, and achieving in order to consider oneself worthwhile (B)
One group consisted of people who had been diagnosed with anxiety. The other group had no psychological problems and they were defined as ‘normal’.
Result:
For statement A, 65% of the anxious participants agreed with the statement compared to 2% of non-anxious participants
For statement B, 80% of anxious participants agreed compared to 25% of non-anxious participants
Conclusion:
People with emotional problems think in irrational ways
Evaluate statistical infrequency
A limitation is that many abnormal behaviours are actually desirable. For example, very few people have an IQ over 150, but this abnormality is desirable not undesirable. Equally, there are some normal behaviours that are undesirable. Experiencing depression, for example, is relatively common but definitely not desirable. Therefore, using statistical infrequency to define abnormality means that we are unable to distinguish between desirable and undesirable behaviours.
An issue is that behaviours that are statistically infrequent in one culture may be statistically more frequent in another. For example, one of the symptoms of schizophrenia is claiming to have voices. However, this is an experience that is common in some cultures. This means that this definition is ethnocentric, and in practice there are no universal standards or rules for labelling a behaviour as abnormal.
Evaluate deviation from social norms
A problem with using deviation from social norms to define behaviour as abnormal as that social norms vary tremendously from one generation to another and from one community to another. This means that a person from one cultural group may label someone from another culture as behaving abnormally, according to their standards, rather than the standards of the person behaving that way. This creates problems for people from one culture living within another culture group.
A limitation of the deviation from social norms definition is it can lead to human rights abuse. Too much reliance on deviation from social norms to understand abnormality can also lead to systematic abuse of human rights. Looking at the historical examples of deviation from social norms, it is pretty clear that these diagnosis were really there to maintain control over minority groups such as queer people and other ethnic groups, and women. However, it could be argued that we need to be able to use deviation from social norms to diagnose conditions such as antisocial personality disorder and schizotypal disorder, where socially unacceptable behaviour is the defining feature of the disorders. This means that the use of deviation from social norms to define abnormality has a history of abuse and may do more harm than good, but it may still have practical applications.
A limitation of the deviation from social norms explanation is it susceptible to abuse. What is socially acceptable now may not have been socially acceptable 50 years ago. For example, today homosexuality is acceptable in most countries in the world, but in the past it was included under sexual and gender identity disorders in the DSM. Similarly, 50 years ago in Russia, anyone who disagreed with the state ran the risk of being regarded as insane and placed in a mental institution. In fact, Thomas Szasz claimed that the concept of mental illness was simply a way to exclude nonconformists from society. Therefore, if we define abnormality in terms of deviation from social norms, there is a real danger of creating definitions based on prevailing social morals and attitudes.
Evaluate failure to function adequately
One strength of the failure to function criterion is that it represents a sensible threshold for when people need professional help. Most of us have symptoms of mental disorder to some degree at sometime. In fact, according to the mental health charity Mind, around 25% of people in the UK will experience a mental health problem in any given year. However, many people press on in the face of fairly severe symptoms. It tends to be at the point that we cease to function adequately that people seek professional help, or are noticed and referred for help by others. This criterion means that treatment and services can be targeted to those who need them most.
Another limitation is that the behaviour may actually be functional. Some apparently dysfunctional behaviour can actually be adaptive and functional for the individual. For example, some mental disorders such as eating disorders or depression may lead to extra attention for the individual. Such attention is rewarding and is quite functional rather than dysfunctional. This failure to distinguish between functional and dysfunctional behaviours means that this definition is incomplete.
One limitation of failure to function is that it is easy to label non-standard lifestyle choices as abnormal. In practice, it can be very hard to say when someone is really failing to function, and when they have simply chosen to deviate from social norms. Not having a job or permanent address might seem like feeling to function, and for some people it would be. However, people with alternative lifestyles choose to live ‘off-grid’. Similarly, those who favour high-risk leisure activities or unusual spiritual practices could be classed, unreasonably, as irrational and perhaps a danger to themselves. This means that people who make unusual choices are at risk of being labelled abnormal, and their freedom of choice may be restricted.
Evaluate deviation from ideal mental health
A major criticism of this definition is that, according to the ideal mental health criteria, most of us are abnormal. Jahoda presented them as ideal criteria and they certainly are. We also have to ask how many need to be lacking before a person would be judged as abnormal. Furthermore, the criteria are quite difficult to measure. For example, how easy is it to assess capacity for personal growth or environmental mastery. This means that this approach may be an interesting concept but not really usable when it comes to identifying abnormality.
Another limitation of this definition is cultural relativism. Many of Jahoda’s mental health criteria are culture bound. For example, the goal of self actualisation is relevant to members of individualistic cultures, but not collectivist cultures where people promote the needs of the group not themselves. If we apply Jahoda’s criteria to people from collectivist cultures or even non-middle-class social groups, we will most probably find a higher incidence of abnormality. This limits the usefulness of this definition to certain cultural groups.
A limitation of this definition is that it tries to apply the principles of physical health to mental health. In general, physical illnesses have physical causes such as a virus or a bacterial infection, and as a result, this makes them relatively easy to detect and diagnose. It is possible that some mental disorders also have physical causes, such as brain injury or drug abuse, but many do not. They are the consequence of life experiences. Therefore it is unlikely that we could diagnose mental abnormality in the same way that we can diagnose physical abnormality.
Evaluate the behavioural approach to explaining phobias
A limitation of the behavioural approach is that phobias do not always develop after traumatic incident. This may be explained in terms of biological preparedness. Seligman argued that animals, including humans, are genetically programmed to rapidly learn an association between potentially life-threatening stimuli and fear. These stimuli are referred to as ancient fears - things that would’ve been dangerous in our evolutionary past. It would have been adaptive to rapidly learn to avoid such stimuli. This would explain why people are much less likely to develop fears of modern objects, such as toasters and cars that are much more of a threat than spiders. Such items were not a danger in our evolutionary past. This suggests that the behavioural approach cannot explain all phobias.
The strength is the two process model is supported by research asking people about their phobias. People with phobias often do recall a specific incident where their phobia appeared, for example, being bitten by a dog or experiencing a panic attack in a social situation. However, not everyone who has a phobia can recall such an incident. It is possible that such traumatic incidents did happen but has since been forgotten. Sue et al suggests that different phobias may be the result of different processes. For example, agoraphobics were most likely to explain their disorder in terms of a specific incident whereas arachnophobics were more likely to cite modelling as a cause. This demonstrates the role of classical conditioning in developing phobias, but other processes may be involved in the maintenance.
A limitation of the two process model is that there are cognitive aspects to phobias that cannot be explained in a traditionally behaviourist framework. An alternative explanation is the cognitive approach which proposes that phobias may develop as a consequence of irrational thinking. For example, a person in a lift may think: ‘I could become trapped in here and suffocate’, which is an irrational thought. Such thoughts create extreme anxiety and may trigger a phobia. The value of this alternative explanation is that it leads to cognitive therapies such as CBT that may, in some situations, be more successful than behaviourist treatments. For example, social phobias respond better to CBT.
Evaluate the behavioural approach to treating phobias
A strength of systematic desensitisation comes from research evidence that demonstrates its effectiveness. McGrath et al found that 75% of patients with phobias were successfully treated using systematic desensitisation. This was particularly true when using in vivo techniques, in which the patient came into direct contact with the feared stimulus, rather than simply imagining in vitro. This shows that systematic desensitisation is effective when treating specific phobias, especially when using in vivo techniques.
However, systematic desensitisation is not effective in treating all phobias. Patients with phobias that have not developed through a personal experience, such as fear of snakes, are not effectively treated using systematic desensitisation. Some psychologists believe that certain phobias have an evolutionary survival benefit and are not the result of learning. This highlights a limitation of systematic desensitisation, which is ineffective in treating evolutionary based phobias which have an innate basis .
One issue with flooding is that it can be highly traumatic for patients since it purposely elicits a high level of anxiety. Wolpe recalled a case with a patient becoming so intensely anxious that she required hospitalisation. Although flooding is not unethical, as patients provide fully informed consent, many patients do not complete their treatment because the experience is too stressful. Therefore, flooding is sometimes a waste of time and money as not all patients engage in the treatment, which will result in the unsuccessful treatment of the phobias.
One issue for behavioural therapies, such as flooding and systematic desensitisation, is symptom substitution. This means that, although one phobia may be successfully removed through counterconditioning, another may appear in its place. If symptoms are treated and removed, the underlying cause may remain, and simply resurface under a new guise. Research in this area is mixed; however, such criticisms are heavily disputed by behaviourist who claim that behavioural treatments provide an ideal treatment for phobias.
A strength of behavioural therapies for dealing with phobias is they are generally relatively faster, cheaper, and require less effort on the patients part than other psychotherapies. For example, CBT requires a willingness for people to think deeply about their mental problems which is not true for behavioural therapies. This lack of thinking means the technique is also useful for people who lack insight into their motivations or emotions such as children or patients with learning difficulties. A further strength of behavioural therapy is that it can be self-administered, which is a method that has proved successful with, for example, with people with social phobias. These benefits were confirmed in a study, which also found that self-administered therapy was as effective as therapist-guided therapy.
Evaluate the biological approach to explaining OCD
A strength is the biological approach has a real world application in that it has led to a successful treatment in the form of SSRIs. The success of SSRIs, which are drugs that increase the availability of serotonin in the brain, supports the view that serotonin is at least part of the cause of the disorder. However, not all people with a low level of serotonin have OCD and some people who have OCD have normal levels of the neurotransmitter so it’s not the sole course. Therefore, the success of SSRIs provide support for the involvement of serotonin, however, this explanation is mainly correlational and lacks the ability to show true cause and effect.
A strength of the biological explanation of OCD comes from research support seen in family and twin studies. Lewis examined patients with OCD and found that 37% of the patients with OCD had parents with the disorder and 21% had siblings who suffered. Nestadt et al identified 80 patients with OCD and 343 of their first-degree relatives and compared them with 73 control patients without mental illness and 300 of their relatives. They found that people with a first-degree relative with OCD had a five times greater risk of having the illness themselves at some point in their life, compared to the general population. A meta-analysis of 14 twin studies was conducted and a 68% concordance rate was found in monozygotic twins compared to 31% in dizygotic twins. This evidence points to a clear genetic basis for OCD, but the fact that the concordance rates are never 100% means that environmental factors must play a role too - the diathesis stress model.
A limitation of the biological approach to explaining OCD is there may be alternative explanations. The two process model can be applied to OCD. Initial learning occurs when a neutral stimulus, such as dirt, is associated with anxiety. This association is maintained because the anxiety provoking stimulus is avoided. Thus an obsession is formed and then a link is learned with compulsive behaviours, such as handwashing, that appear to reduce the anxiety. Such explanations are supported by the success of a treatment for OCD called exposure and response prevention, ERP, which is fairly similar to systematic desensitisation. Patients have to experience the feared stimulus and at the same time are prevented from performing a compulsive behaviour. Studies have reported high success rates, for example, Albucher et al reported that between 60 and 90% of adults with OCD have improved considerably using ERP. This suggests that OCD may have psychological causes, as well as or instead of biological causes.
Evaluate the biological approach to treating OCD
One strength of drug treatment for OCD is good evidence for its effectiveness. There is clear evidence to show that SSRIs reduce symptom severity and improve the quality of life for people with OCD. For example, 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 the placebo conditions. Typically, symptoms reduce for around 70% of people taking SSRIs. For the remaining 30%, most can be helped by either alternative drugs or combinations of drug and psychological therapies. This means that drugs appear to be helpful for most people with OCD. However, there is some evidence to suggest that even if drug treatments are helpful for most people with OCD, they may not be the most effective treatment 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.
A strength of drug therapies is they are often preferred to other treatments. One of the great appeals of using drugs therapies is that it requires little input from the user in terms of time and effort. In contrast, therapies such as CBT require the patient to attend regular meetings and put considerable thought into tackling their problems. Drug therapies are also cheaper for the health service because they require little monitoring and cost less than psychological treatments. Furthermore, patients may benefit simply from talking with the doctor during consultations. These benefits mean drug therapies are more economical for the health service than psychological therapies.
An issue with drug treatments is that they are not a lasting cure for people with OCD. Maina et al found that patients relapse within a few weeks if medication has stopped. Koran et al, in a comprehensive review of treatments for OCD, suggested that, although drug therapy may be more commonly used, psychotherapies such a CBT should be tried first. This suggests that, while drug therapy may require little effort and also may be relatively effective in the short term, it does not provide a lasting cure.
A limitation of drug therapy is that all drugs have side-effects with some more severe than others. For example, nausea, headache, and insomnia are common side-effects of SSRIs. Although not necessarily severe, they are often enough to make a patient stop taking the drugs. Tricyclic antidepressants tend to have more side-effects than SSRIs and so are only used in cases where SSRIs are not effective. The possible side effects of benzodiazepines include aggressiveness and long term impairment of memory. There are also problems with addiction so the recommendation is that they should be used for a maximum of four weeks. The side-effects and the possibility of addiction therefore limit the usefulness of drugs as treatments for OCD.
Evaluate the cognitive approach to explaining depression
A strength of the cognitive approach to explaining depression is it has practical applications in therapy. Both cognitive explanations presented have been applied to CBT. CBT is consistently found to be the best treatment for depression, especially when used in conjunction with drug treatments. The usefulness of CBT as a therapy supports the effectiveness of the cognitive approach - if depression is alleviated by challenging irrational thinking, then this suggests such thoughts had a role in depression in the first place.
A limitation of the cognitive approach is there may be alternative explanations. The biological approach to understanding mental disorders suggests that genes and neurotransmitters may cause depression. For example, research supports the role of low levels of the neurotransmitter serotonin in depressed people, and has also found that a gene related to this is 10 times more common in people with depression. The success of drug therapies for treating depression suggests that neurotransmitters to play an important role. At the very least, a diathesis stress approach might be advisable, suggesting that individuals with a genetic vulnerability for depression are more prone to the effects of living in a negative environment which then leads to negative irrational thoughts. The existence of alternative approaches and effective therapies suggest that depression can’t be explained by the cognitive approach alone.
A strength of Beck’s cognitive theory of depression is it has good supporting evidence. A range of evidence supports the idea that depression is associated with faulty information processing, negative self schemas, and the cognitive triad of negative automatic thinking. For example, Grazioli and Terry assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. They found that those women judged to have been high in cognitive vulnerability were more likely to suffer postnatal depression. Clark and Beck reviewed research on this topic and concluded that there was solid support for all these cognitive vulnerability factors. Critically, this cognitions can be seen before depression develops, suggesting that Beck may be right about cognition causing depression, at least in some cases.
Evaluate the cognitive approach to treating depression
A limitation of the cognitive approach to treating depression is there is an over emphasis on cognition. There is a risk that because of its emphasis on what is happening in the mind of the individual patient, CBT may end up minimising the importance of the circumstances in which a patient is living. A patient living in poverty or suffering abuse needs to change their circumstances, and any approach to therapy that emphasises what is happening in the patient’s mind rather than their environment can prevent this. CBT techniques used inappropriately can demotivate people to change their situation. Therefore, CBT may need to take into account a person’s environmental situation as well as their cognition.
A strength of CBT is it is effective. There is large amounts of evidence to support the effectiveness of CBT for depression. For example, a study by March et al compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with the main diagnosis of depression. After 36 weeks, 81% of the CBT group, 81% of the antidepressants group, and 86% of the CBT plus antidepressants group were significantly improved. Thus, CBT emerged as just as effective as medication and helpful alongside medication. This suggests there is a good case for making CBT the first choice of treatment in public healthcare systems such as the NHS.
A limitation is in the most severe cases of depression, CBT may not work. In some cases, depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. Where this is the case, it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated. Although it is possible to work around this by using medication, this is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression.
A limitation of CBT for the treatment of depression is high relapse rates. Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last. Relatively few early studies of CBT for depression looked at long-term effectiveness. Some more recent studies suggest that long-term outcomes are not as good as had been assumed. For example, in one study, 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, limiting its effectiveness.
