Psychopathology Flashcards
1
Q
What are the four things that can define abnormality
A
- Statistical infrequency
- Deviation from social norms
- Failure to function adequately
- Deviation from ideal mental health.
2
Q
What is statistical infrequency?
A
Statistical infrequency refers to behaviour observed numerically.
- Numerically common behaviour is viewed as “normal”
- Numerically uncommon behaviour is viewed as “abnormal”
The further the behaviour deviates from the statistical norm (e.g: the mean) the more abnormal the behaviour perceived.
3
Q
What is an example of abnormality measured through statistical infrequency?
A
- IQ in intellectual ability.
This is a reliably measured characteristic.
4
Q
What is meant by normal distribution in statistical infrequency?
A
This is where, in statistical measures, scores will cluster around the average, and scores that are located further above or below the mean will become less prevalent.
This is called normal distribution.
5
Q
What is the average IQ and the IQ that can diagnose people as intellectually disabled?
A
- Average IQ: 100 (68% of population)
- Lowest IQs: 70 (2% of population)
6
Q
What is the disorder attributed to an IQ of under 70?
A
Intellectual disability disorder
(IDD)
7
Q
Evaluate statistical infrequency as a definition of abnormality.
A
- Real world application.
One strength of using statistical infrequency as a definition of abnormality is it’s usefulness. Statistical infrequency can be used in clinical practice, both as part of formal diagnosis and as a way to assess severity of symptoms. For example, diagnosis of an intellectual disability disorder requires an IQ of below 70 (bottom 2%). An example of real world application of statistical infrequency is it’s use in the assessment tool Beck Depression Inventory (BDI). A score of 30+ (top 5% of respondents) is widely interpreted as indicating severe depression. This shows that the value of the statistical infrequency criterion is useful in diagnostic and assessment processes. - Unusual characteristics can be positive.
A limitation of statistical infrequency as a definition of abnormality is that infrequent characteristics can be positive, as well as negative. For everyone with an IQ <70, there is someone with an IQ of 130+. Yet, we would not perceive someone as abnormal for having a high IQ. Similarly, we would not think of someone with a very low depression score on the BDI as abnormal. These examples outline that being unusual or at one end of a psychological spectrum does not necessarily make one abnormal. This means that, although statistical infrequency can form part of assessment or diagnostic procedures, it is never sufficient in being the sole basis of abnormality due to lack of application on alternative sides of spectrums.
8
Q
What is deviation from social norms?
A
Where someone behaves in a manner that is different from the accepted standards of behaviour in a community of society.
9
Q
Are accepted social norms universal?
A
NO!
Norms are specific to the culture that we live in.
Social norms are different for each culture, so there are relatively few behaviours that would be considered universally abnormal.
For example, homosexuality was considered abnormal in our culture in the past, yet remains abnormal in other cultures where it is deemed illegal.
10
Q
What is an example of deviation from social norms?
A
- Anti-social personality disorder.
(or psychopathy)
We make the social judgement that psychopaths are abnormal because they don’t conform to and offend our moral standards.
Psychopathic behaviour would be considered abnormal in a very wide range of cultures.
11
Q
Evaluate deviation from social norms as a definition of abnormality
A
- Real world application.
One strength of deviation from social norms is it’s useful application. DFSN can be used in clinical practice for diagnostic purposes. For example, the key defining characteristic of anti-social personality disorder is the failure to conform to culturally acceptable ethical behaviour. Symptoms of the disorder such as recklessness, aggression, violating the rights of others and deceitfulness are all deviations from social norms. Such norms also play a role in the diagnosis of schizotypal personality disorder, where the term ‘strange’ is used to characterize the thinking, behavior and appearance of people with this disorder. This shows that deviation from social norms criterion can have psychiatric use and value. - Cultural and situational relativism.
One limitation of DFSN is the variance between social norms in different cultures, and even different situations. A person from one cultural group may label someone from another group as abnormal using their standards rather than the other individuals cultural standards.
For example, hearing voices is normal in some cultures as a part of spirituality but abnormal in others such as Western cultures. In addition, social norms can differ from one situation to another. Aggressive and deceitful behaviour in the context of family life is more socially unacceptable than in the context of corporate deal-making. This means that it is difficult to judge deviation from social norms across different situations and cultures. - Human rights abuses
A limitation of using deviation from social norms to define someone as abnormal is that it has historical risk of unfair labelling, making individuals vulnerable
to human rights abuses. Historically, diagnosis of nymphomania (female excessive sexual desire) and drapetomania (the running away of slaves) have been historically weaponised, creating violations. This means that this definition of abnormality may be socially sensitive and can risk mistreatment of individuals.
12
Q
What is meant by failure to function adequately as a definition of abnormality?
A
Where someone is unable to cope with the demands of everyday life
13
Q
What are examples of when someone is failing to function adequately?
A
- No longer conforms to standard interpersonal rules such as maintaining eye contact and respecting personal space.
- When a person experiences severe personal distress
- When a persons behaviour becomes irrational or dangerous to others.
14
Q
Who proposed the signs of someone failing to function adequately?
A
Rosenhan and Seligman
15
Q
What is an example of someone failing to function adequately?
A
Intellectual disability disorder.
An individual must be failing to function adequately before a diagnosis would be given.
16
Q
Evaluate “Failure to function adequately” as a definition of abnormality.
A
- Represents a threshold for help
One strength of the failure to function adequately criterion is that is represents a sensible threshold for when people need professional help. Most have symptoms of a mental disorder to some degree at some time. In fact, 25% of people in the UK will experience a MH problem in any given year. Despite this, many are able to persist despite fairly severe symptoms. This criterion identifies when a person would need to be referred to or seek professional help, when one ceases to function adequately. This criterion, therefore, means that treatment and services can be targeted to those most in need of intervention. - Discrimination and social control
A limitation of the failure to function adequately definition is that it is relatively easy to label non-standard lifestyle choices as abnormal. In practice, it can be very hard to judge when someone is failing to function adequately or choosing to deviate. Some individuals, for example, who are not employed or do not have a permanent place of residence could be unreasonably classed, when it could just be an alternative lifestyle. Similarly, those who participate in high-risk leisure activities could be classed as irrational and perhaps a danger to themselves when it is a hobby, such as cliff diving.
This means individuals can be falsely labelled abnormal when they are simply making non-conventional choices, and can have their freedom of choice restricted. - Failure to function not always abnormal
Another limitation of failure to function adequately is that this definition fails to acknowledge the context behind ‘abnormality.’ In some circumstances, such as in the event of bereavement this label may be inappropriate due to their reaction to a difficult circumstance. This means that FTFA may be inappropriate to use in many scenarios as it disregards context.
17
Q
What is deviation from ideal mental health as a definition of abnormality?
A
Where someone does not meet a set of criteria for good mental health.
18
Q
What makes deviation from ideal mental health different from the other definitions of abnormality?
A
It ignores the issue of what makes someone abnormal and and instead considers what makes someone ‘normal’
19
Q
According to Jahoda, what does ideal mental health look like?
A
- No symptoms of distress
- Rational and perceive ourselves accurately
- Self-actualisation
- Cope with stress
- Have a realistic view of the world
- Have a good self esteem and lack guilt
- Independent of other people
- Can successfully work, love and enjoy our leisure
20
Q
Evaluate ‘Deviation from ideal mental health’ as a definition of abnormality.
A
- A comprehensive definition.
One strength of deviation from ideal mental health is that this criterion is highly comprehensive. Jahoda’s concept of ideal mental health includes a range of criteria for distinguishing mental health from mental disorders. This criteria covers most reasons as to why we may seek help (or be referred for) professional psychiatric help. This can be discussed by professionals with different theoretical views, such as a medically trained psychiatrist who focuses on symptoms to a humanistic counsellor who takes interest in self-actualization.
This means that ideal mental health provides a checklist against which we can assess ourselves and others, and discuss psychological issues with a range of professionals with different specialties. - May be culture-bound
One limitation of the ideal mental health criterion is that different elements are not equally applicable across a range of cultures. Much of Jahoda’s criteria is firmly located in the context of Western cultures. In particular, the concept of self-actualization would most likely be dismissed as self-indulgent in most of the world, especially in collectivist cultures. Even within Western cultures there are variations in the value placed on personal independence, such as Germany emphasizing personal independence and Italy having a low value on personal independence. Furthermore, what defines success in our working, social and love-lives is very different in different cultures. This means that it is difficult to apply the concept of ideal mental health from one culture to another. - Extremely high standards
It is relatively impossible to attain and maintain all of Jahoda’s criteria for mental health.
21
Q
What are the DSM-5 categories of phobias?
A
- Specific phobia (situation or object)
- Social phobia/anxiety (social situation)
- Agoraphobia (being outside or in public)
22
Q
What is a phobia?
A
An irrational fear of an object or a situation.
23
Q
What does “cognitive” refer to in characterising disorders?
A
Refers to the process of “knowing”, including thinking, remembering, reasoning and believing.
24
Q
What does “emotional” refer to in characterising disorders?
A
Related to a persons feelings or mood
25
What does “behavioural” refer to in characterising disorders?
The ways in which people act.
26
What are the three behavioural characteristics of phobia?
- Panic
- Avoidance
- Endurance
27
What are the three emotional characteristics of phobia?
- Anxiety
- Fear
- Emotional response is unreasonable
28
What are the three cognitive characteristics of phobia?
- Selective attention to phobic stimulus
- Irrational beliefs
- Cognitive distortions.
29
Describe the behavioural characteristics of phobias.
- Panic: A person with a phobia may panic in response to a phobic stimulus, with response depending on age. People may cry, scream or run away. Children may freeze, cling or have a tantrum.
- Avoidance: They tent to go to a lot of effort to prevent contact w/ phobic stimulus. This can interfere with work, education and social life.
- Endurance: Alternative to avoidance, the person may choose to remain in the presence of the phobic stimulus, opting to keep a wary eye on it as opposed to leaving.
30
Describe the emotional characteristics of phobias.
- Anxiety: phobias are classed as an anxiety disorder, they involve an emotional response of anxiety. This prevents a person from relaxing, making it difficult to experience positive emotion. This can be long term.
- Fear: The immediate and extremely unpleasant response we experience when we confront a phobic stimulus. It is usually more intense but experienced in shorter periods compared to anxiety.
- Emotional response is unreasonable: As fear or anxiety is greater than normal, it is disproportionate to any threat posed.
31
Describe the cognitive characteristics of phobias.
- Selective attention to phobic stimulus: It is hard to look away from the phobic stimulus, used as a mechanism to attempt to react quickly to the threat.
- Irrational beliefs: They may have unfounded thoughts in relation to the phobic stimuli that cannot be easily explained and do not have basis in reality.
- Cognitive distortions: A person may have inaccurate and unrealistic perceptions. They may see the phobic stimuli as uglier or more aggressive than they are in real life.
32
What are all phobias characterised by?
Excessive fear and anxiety, triggered by an object, place or situation.
The extent of the fear is out of proportion to any real danger presented by the phobic stimulus.
33
What is the difference between fear and anxiety?
- Fear is the immediate and extremely unpleasant response that occurs.
This is usually more intense and experienced in shorter period.
- Anxiety is a emotional response, producing an unpleasant state of high arousal.
This can be long-term.
34
What are the DSM-5 categories of depression?
- Major depressive disorder: severe but often short term depression.
- Persistent depressive disorder: long-term or recurring depression.
- Disruptive mood dysregulation disorder: childhood temper tantrums.
- Premenstrual dysphoric disorder: disruption to mood prior to and/or during menstruation.
35
What are the behavioural characteristics of depression?
- Activity levels
- Disruption to sleep and eating behaviour.
- Aggression and self-harm.
36
What are the emotional characteristics of depression?
- Lowered mood.
- Anger
- Lowered self esteem.
37
What are the cognitive characteristics of depression?
- Poor concentration
- Attending to and dwelling on negative.
- Absolutist thinking
38
Describe behavioural characteristics of depression.
- Activity levels: typically they have reduced levels of energy, making them lethargic, leading to withdrawal from work, education and social life. It can also have the opposite effect known as psychomotor agitation where individuals struggle to relax.
- Disruption to sleep and eating behaviour: A person may either experience insomnia or hypersomnia. Appetite may increase or decrease, leading to either weight gain or loss. The key point: behaviours DISRUPTED.
- Aggression and self harm: People with depression are irritable, having potential to become verbally or physically aggressive. Depression can also lead to physical aggression directed against the self.
39
Describe cognitive characteristics of depression.
- Poor concentration: The person may find it hard to stick with a task as they usually would. They may find it hard to make decisions previously considered easy. Poor concentration and poor decision-making are likely to interfere with life.
- Attending to or dwelling on the negative: In a depressive episode, people are more inclined to pay more attention to negative aspects of a situation, ignoring the positives. People also have a bias towards recalling unhappy events rather than happy ones.
- Absolutist thinking: A depressed person will see situations as either all-good or all bad, having a black and white cognitive thinking style. This means that when a situation is unfortunate they are likely to interpret it as an absolute disaster.
40
What is depression?
A mental disorder characterised by low mood and low energy levels.
All forms of depression and depressive disorders are characterised by changes to mood.
41
Describe emotional characteristics of depression.
- Lowered mood: Lowered mood is significant in depression, being more pronounced than the daily experience of feeling sad. People with depression often describe themselves as empty and worthless.
- Anger: People with depression are able to frequently experience anger, even to an extreme extent. This can be directed at the self or at others . Such emotions can manifest behaviourally, being seen in self harm and aggressive behaviour.
- Lowered self esteem: People with depression tend to report reduced self esteem, liking themselves less than usual. This can be extreme, with feelings of self loathing.
42
What is OCD?
A condition characterised by obsessions and/or compulsive behaviour.
43
What are the DSM-5 categories of OCD?
- OCD: characterised by either obsessions (recurring thoughts and images) and/or compulsions (repetitive behaviour).
- Trichotillomania: compulsive hair pulling.
- Hoarding disorder: compulsive gathering of possessions and inability to part with anything.
- Excoriation disorder: compulsive skin-picking.
44
What categories do compulsions and obsessions come under?
- Compulsions: behavioural
- Obsessions: cognitive
45
What are the behavioural characteristics of OCD?
- Compulsions are repetitive
- Compulsions reduce anxiety
- Avoidance
46
What are the emotional characteristics of OCD?
- Anxiety and distress
- Accompanying depression
- Guilt and disgust
47
What are the cognitive characteristics of OCD?
- Obsessive thoughts
- Cognitive coping strategies
- Insight into excessive anxiety
48
Describe the behavioural characteristics of OCD.
- Compulsions are repetitive:
Typically, people with OCD feel compelled to repeat a behaviour.
- Compulsions reduce anxiety:
Compulsive behaviours are performed in attempt to manage the anxiety produced by obsessions.
- Avoidance:
People with OCD may avoid situations in attempt to reduce anxiety from triggers.
49
Describe the emotional characteristics of OCD.
- Anxiety and distress:
OCD is an unpleasant emotional experience due to the powerful anxiety accompanying obsessions and compulsions. Obsessions are frightening, leading to the urge to repeat a behaviour which creates anxiety.
- Accompanying depression:
OCD is accompanied by depression, producing low mood and lack of enjoyment in activity.
- Guilt and disgust:
OCD involves negative emotions such as irrational guilt over minor moral issues, or disgust directed either at something external like dirt or at the self.
50
Describe the cognitive characteristics of OCD.
- Obsessive thoughts:
Obsessive thoughts recur over and over again. Obsessive thoughts are always unpleasant.
- Cognitive coping strategies:
In response to obsessions, people with OCD adopt coping strategies to deal with this. This can help manage anxiety but can make the person appear abnormal to others and disrupt daily tasks.
- Insight into excessive anxiety:
People with OCD are aware that their ideas are irrational !! However, they can experience catastrophic thoughts about worst case scenarios that would result if their anxieties were justified.
They are also hyper vigilant.
51
What is the name given to the model used to explain phobias?
The two process model.
52
What approach explains phobias?
The behavioural approach.
53
How do classical conditioning and operant conditioning affect phobias?
- Classical conditioning leads to the acquisition of phobias.
- Operant conditioning means the phobia can persist, being maintained.
54
What study supports classical conditioning as an explanation for the onset of phobia?
Little Albert.
55
How did Albert develop a fear of white rats?
Every time Little Albert encountered a white rat, the researchers made a loud and frightening sound using an iron bar.
In this, the noise is the unconditioned stimulus - leading to an unconditioned response of fear.
When a rat, being a neutral stimulus is paired with the UCS, the neutral stimulus rat because associated with the UCS, producing a fear response.
Eventually, the rat becomes a conditioned stimulus that produced a conditioned response.
This conditioning then became generalised to other similar objects.
56
How does operant conditioning maintain phobias?
- Negative reinforcement: an individual will avoid a situation that is unpleasant, this removes the threat of the phobic stimulus - creating the desirable consequence of lowering anxiety. This reinforces the behaviour.
- Positive reinforcement
57
Who carried out the Little Albert study?
Watson and Rayner.
58
Evaluate the behavioural approach to explaining phobias.
- Real world application:
One strength of the two process model is it's real world application surrounding exposure therapy treatment. The distinctive element of the two process model is that it proposes that phobias are maintained by avoidance of the phobic stimulus.
This holds importance in explaining why people benefit from flooding or systematic desensitisation, being exposed to the phobic stimulus.
Once avoidance is prevented it ceases to be reinforced by the experience of anxiety reduction, so avoidance can therefore decline.
In behavioural terms, phobia *IS* the avoidance behaviour, so, limiting this treats the phobia, and cures it when it is prevented. This shows the value of the two-process model approach as it can identify means of treating phobias.
- Disregard for cognitive aspects
One limitation of the two-process model is that it fails to account for the cognitive aspects of phobias. Behavioural explanations, such as the two-process model, are geared towards explaining *behaviour*. In this case, the key behaviour is avoidance of the phobic stimulus. Despite this, We know that phobias cannot be reduced to only behavioural components, they have significant cognitive components such as cognitive distortion or irrational beliefs about the phobic stimulus. The two-process model only offers an explanation to avoidance behaviour of a phobia, but does not offer an adequate explanation to why phobic cognitions develop.
This means that the two-process model does not completely explain other significant symptoms of phobias.
- Research support:
A further strength of the two-process model is evidence for a link between phobias and traumatic experiences. Originally, the Little Albert study illustrated how a frightening experience involving a stimulus can lead to a phobia of that stimulus. More systematic evidence comes from a study linking phobia of dental treatment to negative experiences. A study on individuals with a phobia of dental treatment found that 73% of people with a fear of dental treatment had undergone a bad experience mostly involving dentistry.
This was compared to a control group of people with low dental anxiety where only 21% had experienced a traumatic event.
This confirms phobia acquisition through classical conditioning, due to the association between the stimulus (dentistry) and an unconditioned response (pain).
- Counterpoint: Absence of trauma.
In counterpoint to the previous study, not all phobias develop following negative experiences. A common phobia of snakes still exist in populations where there is little exposure to snakes, let alone traumatic experiences surrounding it.
Extending this, not all traumatic experiences lead to phobias. This means that association between phobias and frightening experiences is not as strong as we could expect from the two-process model. This undermines the behavioural theory of acquisition of phobias.
59
What are the two behavioural ways to treat phobias?
- Systematic desensitisation
- Flooding
60
What is the difference between flooding and systematic desensitisation?
- Flooding exposes people to a phobic stimulus without gradual build up on an anxiety hierarchy.
- Flooding sessions are typically longer than systematic desensitisation in session length: lasting up to 3 hours as opposed to short intervals.
61
What are the three stages of systematic desensitisation?
- Creating an anxiety hierarchy
- Relaxation
- Exposure.
62
What is systematic desensitisation?
A behavioural therapy designed to reduce anxiety surrounding the phobic stimulus through the principles of classical conditioning.
63
What occurs during systematic desensitisation?
Counter-conditioning:
Learning a new response to the phobic stimulus (phobic stimulus is paired with relaxation instead of anxiety)
64
Outline the procedure of systematic desensitisation.
An 'anxiety hierarchy' is put together by the client and the therapist. This is a list of situations related to the phobic stimulus that trigger anxiety arranged in order from least frightening to most frightening.
Next, the therapist will teach the client to relax as deeply as possible, this is because it is impossible to be relaxed and afraid at the same time, so one emotion prevents the other.
This is called RECIPROCAL INHIBITION.
Lastly, the client is finally exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, starting at the bottom of the anxiety hierarchy.
Once the client can stay relaxed in the presence of lower levels in the anxiety hierarchy, they move up the hierarchy.
65
What is reciprocal inhibition?
Reciprocal inhibition is the inhibition of a fear response from a phobia, replacing it with relaxation. This ultimately refers to how it is not possible to have both fear and relaxation at the same time.
66
How would a therapist teach someone how to relax in systematic desensitisation?
The therapist may administer breathing exercises or help the client learn mental imagery techniques (such as imagining themselves in a relaxing environment)
Alternatively, they can use relaxant drugs such as Valium.
67
Evaluate systematic desensitisation.
- Evidence of effectiveness.
One strength of systematic desensitisation is the evidence base for it's effectiveness. There is research evidence from a follow up of 42 people who had underwent SD for arachnophobia. These 42 individuals were treated in 3 45-minute sessions. At both a 3 and 33 weeks follow up after treatment, the SD group were less fearful than a control group who underwent relaxation without exposure.
This is reinforced by a review that concluded that SD is effective for specific phobia, social phobia and agoraphobia. This means that SD is likely to be helpful for people with phobias.
- Learning disability
A further strength of SD is that it can be applied to people who have learning disabilities. Many individuals with learning disabilities have phobias that require treatment, and alternatives to SD are not suitable. People with learning disabilities may struggle with cognitive therapies that require complex and rational thought articulation. Furthermore, alternate exposure therapies such as flooding may distress the patient and cause confusion.
SD minimizes the chance that those with learning disabilities respond negatively as it is less traumatic. This means that SD is a more appropriate treatment for people with both learning disabilities and phobias.
68
What is flooding?
A behavioural therapy for phobias in which a client is exposed to an extreme and immediate form of a phobic stimulus.
69
How long are flooding sessions?
Can last up to 3 hours in duration.
In length, as little as one session can 'cure' a phobia.
70
How does flooding work?
Flooding is where a client is exposed to an extreme form of phobic stimulus without build up.
From this, avoidance is prevented so the client quickly learns that the phobic stimulus is harmless.
The client calms down on their own, with this sometimes occurring due to exhaustion.
71
What occurs during flooding when curing a phobia?
Extinction
A learned phobic response is extinguished when the conditioned phobic stimulus (for example, a spider) is encountered without the unconditioned stimulus (being bitten).
The result is that the conditioned stimulus would no longer produce the conditioned response (fear)
72
What ethics come with flooding and how do you deal with it?
Flooding is not unethical, however, due to it being an unpleasant experience informed consent is required.
The traumatic procedure requires that the client is fully informed and prepared before the flooding session.
In addition, the client is offered the option of systematic desensitisation as an alternative.
73
Evaluate flooding in treating phobias.
- Cost effective
One strength of flooding is that it is highly cost effective. Clinical effectiveness refers to how effective a therapy is at tackling symptoms. Flooding sessions are regarded as clinically effective, so they are efficient in tackling symptoms. When we provide therapies in health systems such as the NHS, we need to consider how much these cost. A therapy can be regarded cost-effective if it is clinically effective and not expensive. Flooding requires a smaller number of sessions (as little as one session) as opposed to SD (which can extend past 10 sessions).
This means that people can be treated with flooding at a lower cost and more efficiently as opposed to treatment with other therapies such as SD.
- Traumatic
One limitation of flooding is that it is a highly unpleasant experience. Confronting an extreme phobic stimulus in an extreme form provokes tremendous anxiety. A study showed that both patients and doctors rated flooding as significantly more stressful than SD. The consequence of this is that flooding produces high rates of attrition (drop out) due to the stressful nature of the treatment. In addition, this raises the ethical issue for psychologists of knowingly causing stress to their clients, even with informed consent.
This means that, overall, therapists may opt to avoid this treatment due to the potential psychological harm and abandonment.
74
What two models explain depression?
- Beck's negative triad
- Ellis's ABC model.
75
What is the cognitive approach?
An approach focused on how our mental processes (thoughts, perceptions and attention) influence behavior.
76
What approach explains and treats depression?
The cognitive approach
77
What are the three parts of Beck's cognitive vulnerability?
- Faulty information processing
- Negative self schema
- The negative triad
78
What does Beck mean by faulty information processing?
When depressed people attend to the negative aspects of a situation and ignore the positives.
Depressed people may tend towards 'black and white thinking' where something is either all bad or all good.
79
What did Beck mean by a negative self schema?
A negative self schema is the package of information people have about themselves.
People use schema to interpret the world, so if a person has a negative self schema they interpret all information about themselves in a negative way.
80
What is the negative triad?
Proposed by Beck, the negative triad encapsulates 3 types of negative thinking that contributes to developing a dysfunctional view of themselves.
81
What are the three sections of Beck's negative triad?
- Negative view of the world
- Negative view of the future
- Negative view of the self
82
Who made the negative triad?
Aaron Beck
83
Who made the ABC model?
Albert Ellis
84
What is the ABC model?
A model to explain how irrational thoughts affect our behavior and emotional state.
85
What is an irrational thought, according to Ellis?
Any thoughts that interfere with us being happy and free from pain.
86
What does ABC stand for in Ellis's ABC model in explaining depression?
A: Activation event
B: Beliefs
C: Consequences
87
What is meant by A: activating event in Ellis's ABC model?
- This is where a situation where irrational thoughts are triggered by external events.
- According to Ellis we become depressed when we experience negative events that trigger irrational beliefs.
88
What is meant by cognitive vulnerability?
Cognitive vulnerability refers to ways of thinking that may predispose someone becoming depressed.
89
What is meant by B: Beliefs in Ellis's ABC model?
Irrational beliefs shaped by experiencing external events.
For example:
- 'Musturbation': Belief that we must always succeed.
- 'I-can't-stand-it-itis': Belief that not going smoothly a major disaster
- Utopianism: Belief that life is always meant to be fair.
90
What is meant by C: Consequences in Ellis's ABC model?
The emotional and behavioral consequences following when an activating event triggers irrational beliefs.
91
Evaluate Beck's negative triad: the cognitive approach to explaining depression.
- Research support:
One general strength of Beck's cognitive model of depression is the existence of supporting research. 'Cognitive vulnerability' are ways of thinking that can predispose a person to become depressed, for example faulty information processing, negative self schema and the negative triad.
Beck, in a review, concluded that cognitive vulnerabilities were more common in depressed people, and were also found to precede the depression.
Cohen supported this in a prospective study tracking the development of adolescents, regularly measuring cognitive vulnerability. It was found that cognitive vulnerability predicted later depression. This shows, as Beck suggested, there is an association between cognitive vulnerability and depression.
- Real world application:
A further strength of Beck's cognitive model is its application to screening and treatment of depression.
Cohen concluded that assessing cognitive vulnerability allows psychologists to screen young people, allowing identification and monitoring of those who are at the highest risk of developing depression.
Understanding cognitive vulnerability also contributes to the field of treatment in CBT - working to alter the cognitions that make one vulnerable to depression, and making them more resilient to negative life events. This means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice.
92
Evaluate Ellis's ABC model: the cognitive approach to explaining depression.
- Real world application
One strength of Ellis's ABC model is that can be used in real world psychological treatment of depression. Ellis's treatment approach is named 'rational emotive behavior therapy'. REBT centers around the idea of vigorously arguing with the patient until the therapist can alter the belief making them unhappy. Research has suggested that REBT can both change negative beliefs and relieve the symptoms of depression. This suggests that REBT has real-world value.
- Reactive vs endogenous depression
A limitation of Ellis's model is that it only accounts for reactive depression, not endogenous depression.
Reactive depression is where depression is triggered by a negative life event whereas endogenous depression is where depression does not correlate with a negative life event. Ellis's ABC model only explains the formation of reactive depression due to an activating event, not explaining other causes. This means that Ellis's model can only explain some cases of depression, being a partial explanation.
93
What does CBT stand for?
Cognitive behavioral therapy
94
What does REBT stand for?
Rational emotive behavioral therapy
95
What is CBT?
A treatment for mental disorders based on both cognitive and behavioral techniques.
96
What does CBT entail?
- Cognitive element:
CBT begins with an assessment where the client and therapist work together to clarify the clients 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 thoughts.
- Behavioral element:
CBT then involves working to change negative and irrational thoughts, putting more effective behaviors into place.
97
What does Beck's cognitive therapy involve?
- Includes the idea of identifying automatic thoughts about the world, the self and the future.
Once identified these thoughts must be challenged - this is the central component of the therapy.
- Cognitive therapy also involves aiming to help clients test the reality of their negative beliefs - setting homework such as recording when they enjoyed an event.
This is referred to as the 'client as scientist'.
The therapist can use evidence collected to challenge their beliefs.
98
How does REBT extend the ABC model?
- It makes it the ABCDE model.
- D is for Dispute
- E is for Effect
99
What does REBT involve?
The central technique is to identify and dispute (challenge) irrational thoughts.
The therapist vigorously argues with the client intending to change the irrational belief and break the link between negative life events and depression.
For example!
- Empirical argument: disputing whether there is evidence to support the negative beliefs
- Logical argument: disputing whether the negative thought logically follows the facts.
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What is behavioral activation in the cognitive treatments?
As individuals become depressed, they tend to avoid difficult situations and isolate themselves which maintains or worsens the symptoms. Behavioral activation is the treatment for this,
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What is the goal of behavioral activation?
To work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that boost mood (exercise, going to dinner etc)
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Evaluate the cognitive treatments for depression.
- Evidence for effectiveness
One strength of CBT is that there is a large body of evidence to support its effectiveness in treating depression. Many studies illustrate that CBT works. In one study, CBT was compared to anti-depressant drugs and also these in combination when treating depressed adolescents. After 36 weeks, 81% of the anti-depressant group, 81% of the CBT group and 86% of the combination group significantly improved. So, CBT was just as effective when used singularly and more when used alongside antidepressants. In addition, CBT is usually a brief therapy requiring 6-12 sessions, so it is also cost effective. This means that it is perceived as the first choice of treatment in public healthcare systems such as the NHS.
- Lack of suitability for diverse clients
One limitation of CBT for depression is lack of effectiveness for severe cases and for clients with learning disabilities. In some severe cases, people with depression cannot be motivated to engage with the cognitive work of CBT and may not be able to maintain attention to what is happening in a session. For those with learning disabilities, complex rational thinking involved with CBT makes this inappropriate treatment. It has been suggested that, in general, any form of psychotherapy is not suitable for clients with learning disabilities, including CBT. This means that CBT may only be appropriate for a select and specific range of people with depression.
- Relapse rates
A further limitation of cognitive treatments is high relapse rates. Although CBT is quite effective in tackling symptoms of depression, a major concern is how long the benefits last. Relatively few studies looking at CBT are longitudinal to show long-term effectiveness. Recent studies undermined CBTs effectiveness. One study suggested CBT was not as good as once assumed through looking at long term outcomes. For example, a study assessing depression in clients followed progress monthly for 12 months following a course of CBT. 42% of clients relapsed within 6 months of finishing CBT whilst 53% relapsed within a year.
This implies that CBT does not have long term benefits and may require periodic repeats.
- Client preference
One limitation of CBT is presence of client preference. CBT does focus on identifying and altering unhelpful patterns of behavior and thinking, and when used with the correct clients it is effective. Despite this, not all want to be treated in this manner. Some people may opt for medication to quickly suppress symptoms without disruption to daily life. Others, such as those who have been through trauma may wish to explore the origins of symptoms through psychotherapy. Consolidating this, in a study on client preference, it was found that people with depression rated CBT as their least preferred psychological therapy. This suggests that CBT can only target certain elements of treatment which may lead people to select more personalized alternatives.
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What is the biological approach?
A perspective that emphasizes the importance of physical processes in the body such as genetic inheritance and neural function.
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What is the diathesis stress model?
Genes leave some people more likely to develop a mental disorder but this is not certain. Some environmental stress is necessary to trigger the condition.
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What approach is used to explain and treat OCD?
The biological approach.
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What study outlined genetics in vulnerability to OCD?
Lewis.
He observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD.
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What are candidate genes?
Genes that create vulnerability for OCD.
For example, some of these genes are involved in regulating the development of the serotonin system.
The gene 5HT1-D beta is implicated in the transport of serotonin across synapses.
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What is meant by OCD being polygenic?
This means that OCD is not caused by a single gene, but by a combination of genetic variations that together significantly increase vulnerability.
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Outline the study that supports OCD being polygenic.
Taylor.
Analyzed findings of previous studies and found that up to 230 genes may be involved in OCD.
Genes studied have association with the action of dopamine and serotonin - neurotransmitters believed to have a role in regulating mood.
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What comes under genetic explanations for OCD?
- Candidate genes
- Polygenic
- Types of OCD (heterogenous aetiology)
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What does heterogenous aetiology mean?
One group of genes that cause OCD in one person may be different to a combination of genes that caused the disorder in another person.
The origins (aetiology) of one person may vary from one person to another (heterogenous).
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What is a neural explanation?
The view that physical and psychological characteristics are determined by the behavior of the nervous system, in particular the brain and individual neurons.
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What is the role of serotonin in OCD?
An explanation for OCD surrounds the idea that low levels of serotonin (a neurotransmitter) may cause this disorder. If a person has low levels of serotonin then normal transmission of mood relevant information does not take place - leading a person to experience low mood and affected mental processes.
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What are neurotransmitters responsible for?
Relaying information from one neuron to another.
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What role does 'decision making systems' play in OCD?
Some cases of OCD can be attributed with impaired decision making.
This is associated with the lateral sections on the frontal lobes functioning abnormally, impairing logical thinking and decision making. In addition, the left parahippocampal gyrus may be malfunctioning causing faulty processing of unpleasant emotions.
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What areas of the brain may be affected when someone has OCD?
- (lateral section of) Frontal lobes
- Left parahippocampal gyrus
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What are the frontal lobes responsible for?
Responsible for logical thinking and making decisions.
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What is the left parahippocampal gyrus associated with?
Associated with processing unpleasant emotions (functions abnormally in OCD)
119
Evaluate genetic explanations for OCD
- Research support
One strength for the genetic explanation of OCD is that there is a strong evidence base. There is evidence from various sources which suggest that some people are vulnerable to OCD from their genetic makeup.
One source of evidence is twin studies. In one twin study, a psychologists review found that 68% of identical twins (MZ) shared OCD traits as opposed to 31% in non-identical twins (DZ). In addition, family studies research has found that a person with a family member diagnosed with OCD is around 4x more likely to develop the disorder compared to someone else without diagnosed family. These research studies suggests there must be some genetic influence on the development of OCD.
- Environmental risk factors
One limitation of the genetic model is that there are environmental risk factors for OCD. There is strong evidence for the idea that genetic variation can make a person more or less vulnerable to OCD. OCD does not appear to be entirely genetic in origin, environmental risk factors have been found to trigger or increase risk of developing OCD. In one study, it was found that over half of the OCD clients in the sample had experienced a traumatic event in their past. Also, OCD symptoms were also more severe in those with one or more traumas. This implies that genetic vulnerability only provides a partial explanation for OCD.
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Evaluate neural explanations for OCD.
- Research support
One strength of the neural model of OCD is existence of supporting evidence.
Anti-depressants that work purely on serotonin are effective in reducing OCD symptoms, and this suggests that serotonin may be involved in OCD.
In addition, OCD symptoms form part of conditions that are biological in origin. For example, someone with Parkinson's disease will experience similar symptoms to those in the disorder. If a biological disorder surrounding degeneration of the brain produces OCD symptoms, we may assume that biological processes underlie OCD. This suggests that biological factors (such as serotonin and processes underlying some disorders) may also be responsible for OCD.
- No unique neural system.
A limitation of the neural model is that the serotonin-OCD link may not be unique to OCD. Many people with OCD experience clinical depression, having two disorders is called co-morbidity. Depression also involves disruption to the action of serotonin. This leaves the logical problem that OCD may not be due to serotonin deficiency, as co-morbid depression may be equally as responsible for it. This means that serotonin may not be relevant to OCD symptoms due to presence of other disorders.
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What are the three types of drugs used to treat OCD?
- SSRI's
- SNRI's
- Tricyclics
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What does SSRIs stand for ?
Selective serotonin reuptake inhibitors
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How does serotonin work in the neural system?
Serotonin is released by neurons called the presynaptic neurons and travel across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the post synaptic neuron and then is reabsorbed by the presynaptic neuron where it is broken down and reused.
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What do SSRI's do to the neural system?
SSRIs prevent the absorption and breakdown of serotonin back into the presynaptic neuron, increasing the levels of serotonin in the synapse and thus continue to stimulate the post synaptic neuron.
125
What is the average dosage of the SSRI fluoxetine?
20mg average in liquid or tablet form - can be increased if it does not benefit the person and takes 3-4 months of daily use to have an effect. Can be increased up to 60mg
126
What are tricyclics?
An older type of anti-depressant that act on various systems including the serotonin system where it has the same effects of SSRIs.
It normally has more severe side effects so it is kept in reserve for those who do not respond to SSRIs
127
What is an example of a tricyclic?
Clomipramine
128
What does SNRIs stand for?
SEROTONIN-noradrenaline reuptake inhibitors.
129
What do SNRIs do?
A different class of anti-depressant drugs that are a second line of defense for people who who do not respond to SSRIs
SNRIs increase levels of serotonin as well as the neurotransmitter noradrenaline which are believed to regulate mood.
130
Evaluate the biological approach to treating OCD
- Evidence for effectiveness
One strength of drug treatment for OCD is evidence for effectiveness. It has been shown that SSRIs reduce symptom severity and improve the quality of life for people with OCD. For example, a review of 17 studies comparing SSRIs to placebos all showed significantly better outcomes for SSRI users in comparison to the placebo conditions. Typically, symptoms reduce around 70% for people on SSRIs and the remaining 30% can be supported by alternative drugs and psychological treatments. This means that drugs appear to be helpful in treating OCD.
- Cost-effective and non-disruptive
One further strength of drugs to treat OCD is that they are non-disruptive to daily life and more cost effective for health systems. Drug treatment for psychological disorders in general is relatively cheaper compared to psychological treatments. Many medications can be produced in the time taken to conduct a therapy session. This means that using drugs is therefore good in value for public health systems such as the NHS - representing good use of limited funds. As compared to psychological therapies, SSRIs tend not to be disruptive to peoples daily life in terms of schedules.
SSRIs can be simply taken till symptoms decline, rather than relying on psychological therapy which involves time spent attending sessions. Drug usage is, therefore, more popular with many people and professionals.
- Serious side effects
A limitation is that drugs potentially have damaging side effects. Although drugs, such as SSRIs appear to work on most people, a minority will gain no benefit or be physically impacted. Some people may experience side effects such as indigestion, blurred vision and loss of libido. Despite these usually being temporary, they can be distressing and for a minority of people this can be long lasting, especially if taking tricyclics where side effects are more common and severe. 1 in 10 experience erectile dysfunction and weight gain and 1 in 100 become aggressive and experience heart problems. This means that it can reduce quality of life for many and they may stop taking medication all together - worsening symptoms as a result.
- Biased evidence
One limitation of drug therapy is potential for bias in evidence. A major concern surrounding evidence for medications effectiveness is that the evidence is biased due to research being sponsored by drug companies, leading to the potential for selective publishing of positive results. In addition, there is a lack of independent studies carried out into the effectiveness of drugs due to pharmaceutical companies usually providing the necessary funds for these.
This means that one may not be able to fully conclude that drugs to treat psychiatric disorders are effective in the way portrayed.
131
What is included in the 'statistical infrequency' as a definition of abnormality topic?
- What is meant by statistical infrequency
- Example of SI, of IQ and intellectual disability disorder.
- Normal distribution
132
What is included in the 'deviation from social norms' as a definition of abnormality topic?
- What is meant by deviation from social norms
- Norms being specific to the culture we live in
- Example of DFSN: Anti-social personality disorder.
133
What is included in the 'failure to function adequately' as a definition of abnormality topic?
- What is meant by failure to function adequately
- Rosenhan and Seligman's signs of FTFA: no longer conforming to standard interpersonal rules such as maintaining eye contact and respecting personal space, experiencing severe personal distress and behaviour becoming irrational and dangerous to themselves or others.
- Example of FTFA: Intellectual disability disorder (needs to have FTFA for diagnosis)
134
What is included in the 'deviation from ideal mental health' as a definition of abnormality topic?
- What is meant by deviation from ideal mental health
- Jahoda's ideal mental health criteria: no symptoms of distress, rational and perceive self accurately, self-actualization, coping with stress, realistic view of the world, good self esteem and lack guilt, independent of other people and can successfully work, love and enjoy our leisure.
135
What is included in the topic 'phobias' ?
- What a phobia is
- DSM-5 phobia categories: specific phobia, social anxiety and agoraphobia
- Behavioral characteristics of phobia: panic, avoidance and endurance
- Cognitive characteristics of phobia: selective attention to phobic stimulus, irrational beliefs and cognitive distortions
- Emotional characteristics of phobia: anxiety, fear and the emotional response being unreasonable.
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What is included in the topic 'depression' ?
- What depression is
- DSM-5 categories: major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder, premenstrual dysphoric disorder
- Behavioral characteristics of depression: activity levels, disruption to sleep and eating behavior, aggression and self-harm
- Cognitive characteristics of depression: poor concentration, attending to or dwelling on the negative, absolutist thinking
- Emotional characteristics of depression: lowered mood, anger, lowered self-esteem.
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What is included in the topic 'OCD' ?
- What OCD is
- DSM-5 categories of OCD: OCD, trichotillomania, hoarding disorder and excoriation disorder.
- Behavioral characteristics of OCD: Compulsions are repetitive, compulsions reduce anxiety, avoidance
- Cognitive characteristics of OCD: Obsessive thoughts, cognitive coping strategies, insight into excessive anxiety
- Emotional characteristics of OCD: anxiety and distress, accompanying depression, guilt and disgust.
138
What is included in the topic 'the behavioral approach to explaining phobias' ?
- The two-process model, proposed by the behavioral approach
- How phobias are *acquired* by classical conditioning
- Watson and Rayner's Little Albert study showing classical conditioning in the onset of phobias
- How phobias are maintained by operant conditioning: negative reinforcement AND positive reinforcement.
139
What is included in the topic 'the behavioural approach to treating phobias' ?
- Systematic desensitisation (counterconditioning)
- The three processes under systematic desensitisation: creating an anxiety hierarchy, relaxation (via reciprocal inhibition) and exposure.
- Flooding
- How flooding works (extinction when a conditioned stimulus is encountered without the unconditioned stimulus)
- Ethical safeguards to flooding
140
What is included in the topic 'the cognitive approach to explaining depression' ?
- Beck's negative triad - 3 parts to cognitive vulnerability
- BNT: Faulty information processing, negative self-schema
- The negative triad: 3 elements - *negative view of world*, *negative view of the future* and *negative view of the self*.
- Ellis's ABC model
- Ellis's idea of irrational thoughts
- ABC Model: *activating event*, *beliefs* (including: utopianism, 'musturbation' and 'I-Cant-Stand-It-Itis' and *consequences*.
141
What is included in the topic 'the cognitive approach to treating depression' ?
- Cognitive behavioural therapy
- The process of CBT: cognitive element and behavioural element
- Beck's cognitive therapy, challenging the negative triad, 'client as scientist' that has homework to produce evidence to challenge negative thought
- Ellis's Rational Emotive Behavioural Therapy
- REBT extending the ABC model to ABCDE (D= dispute, E= effect).
- REBTs methods of disputing: *empirical argument* and *logical argument*
- Behavioural activation
142
What is included in the topic 'the biological approach to explaining OCD'
- Genetic explanations (Lewis: 37% parents OCD, 21% siblings OCD)
- Genetic explanations including: candidate genes, OCD being polygenic (Taylor), OCD being *aetiologically heterogeneous* (origins vary from one person to another),
- Neural explanations
- Neural explanations including: role of serotonin, decision-making systems (abnormal functioning of the frontal lobes and left parahippocampal gyrus).
143
What is included in the topic 'the biological approach to treating OCD' ?
- Drug therapy
- SSRIs (selective serotonin reuptake inhibitors)
- How SSRIs work in synapses
- Combining SSRIs with other treatments such as CBT
- Alternatives to SSRIs: SNRI's and Tricyclics
