Psychopathology Flashcards
What is psychopathology?
The study of psychological disorders
What are the four definitions of abnormality?
- Statistical infrequency
- Deviation from social norms
- Deviation from ideal mental health
- Failure to function adequately
What is statistical infrequency?
Anything usual is seen as normal, anything unusual occurring occasionally, is seen as abnormal
What are the strengths and weaknesses of statistical infrequency?
+ Objective measure as it doesn’t rely on social norms or opinions
- Makes the assumption that any abnormal characteristics are automatically negative but this isn’t always the case
What is deviation from social norms?
Anything which is considered strange by the people of a particular society
What are the strengths and weaknesses of deviation from social norms?
+ Helps society: Adhering to social norms means that society is ordered and predictable
- Suffers from cultural relativism
- Depends on the time period
What is deviation from ideal mental health?
Suggests that abnormal behaviour should be defined by the absence of particular criteria - Jahoda’s criteria
What are Jahoda’s criteria for ideal mental health?
- Self-esteem
- Self-actualisation
- Independent and self-reliant
- Resistance to stress
- Mastery of environment
- Accurate perception of reality
What are the strengths and weaknesses of deviation from ideal mental health?
+ Positive approach as it focuses on what is helpful and desirable for the individual
- Unrealistic criteria and it’s impossible to achieve all of them
- Suffers from culture relativism
- Criteria is subjective and difficult to measure
What is failure to function adequately?
Circumstances where a person is unable to cope with demands of every day life
What are the strengths and weaknesses of failure to function adequately?
+ Take’s into account the patient’s perspective - the final diagnosis is comprised of the patient’s subjective self reported symptoms (accurate)
+ Represents a threshold for help - the criterion means that treatment can be targeted to those who need it most
- Could lead to labelling of a patient as crazy which isn’t useful if they already live a high quality life
What is a phobia and what are the 3 main types?
An irrational fear of an object or situation
- Specific phobia
- Agoraphoria: fear of a public place
- Social phobia (social anxiety): intense fear and anxiety in social situations
What are the behvaioural characteristics of phobias?
- Panic: crying, screaming, running away
- Endurance: the person remains in presence of the phobic stimulus but still experiences anxiety
- Avoidance: avoid coming into contact with the phobic stmiulus
What are the emotional characteristics of phobias?
- Anxiety
- Fear
- Irrational and disproportionate emotional response
What are the cognitive characteristics of phobias?
- Selective attention: the patient remains focused on the phobic stimulus even if it’s causing them anxiety
- Irrational beliefs
- Cognitive distortions: the patient doesn’t perceive the phobic stimulus accurately
What is the behavioural explanation of phobias?
What are the strengths of the behavioural explanation of phobias?
- Good explanatory power: Mowrer’s two-process model explains how phobias can be maintained - important implications for therapies as it explained why patients need exposure to feared stimulus(real-life application)
- Evidence for a link between bad experiences and phobias - the association between stimulus and UCR -> phobia (Little Albert)
What are the weaknesses of the behavioural explanation of phobias?
- An incomplete explanation of phobias: Bounton showed that evolutionary factors play a role in explaining phobias - Seligman called this biological preparedness (the innate predisposition to acquire certain fears)
- Some phobias don’t follow a traumatic experience: someone might fear snakes but have never encountered one - contradicts key aspect of mowrer’s model
- Ignores the cognitive aspects of behaviour: although behavioural explanation,including two-process model, is oriented towards explaining behaviour (avoidance) than cognition, phobias still have a cognitive element (e.g. irrational beliefs) - reductionist
What are the two behavioural approaches to treating phobias?
- Systematic desensitisation
- Flooding
What is systematic desensitisation?
- Aims to reduce phobic anxiety through gradual exposure to phobic stimulus
- Anxiety hierachy is constructed of situations involving the phobic stimulus
- Taught relaxation techniques and reciprocal inhibition takes place
- Patient works their way up hierachy until no anxiety is felt at highest level
What evidence did Gilroy et al provide for systematic desensitisation?
- Gilroy et al. (2003) followed up 42 people who had SD for spider phobia in three 45-min sessions
- At both three and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure
What are the strengths of systematic desensitisation?
- Proven successful by Gilroy et al. (2003): a group of 42 patients who had systematic desensitisation as a treatment for arachnaphobia over 3 45 minutes sessions - at both 3 and 33 months they were less fearful compared to the control group
- Suitable for patients with learning difficulties: doesn’t require a huge cognitive load or evaluating their own thoughts
What are the weaknesses of systematic desensitisation?
- Less effective for evolutionary phobias: certain phobias, like heights, have an evolutionary survival benefit and are not the result of personal experience, but of evolution.
- Leads to symptom substitution: treats the symptoms not the cause - may leave patient vulnerable to other phobias developing as the root behind the fear has yet to be uncovered
What is flooding?
- Patient is exposed to phobic stimulus in a secure environment
- No option of avoidance behaviour so can’t be reinforced -> phobia isn’t maintained
- Flooding sessions typically longer than SD, lasting 2-3hrs
- Clients must give informed consent
What are the strengths of flooding?
- Cost-effective: often only one session (SD requires 10 sessions) is needed, thus freeing them of their phobia and allowing them to live a normal life
- Works very well with ‘simple’ phobias e.g. phobias of one specific thing or object
What are the weaknesses of flooding?
- Less effective for complex phobias: social phobias involve both anxiety and a cognitive aspect - cognitive therapy would be more appropriate
- Traumatic: unpleasant experience, & if the patient panics & the treatment is not completed, it may leave them with an even worse fear/phobia of the object/event (Schumacher et al found ppts & therapists rated flooding as significantly more stressful than SD) - waste of time and money
What is depression?
What are the four categories?
A mood disorder, where the sufferer experiences low mood and low energy levels
- Major depressive disorder: severe but short-term
- Persistent depressive disorder: long term including sustained major depression
- Disruptive mood dysregulation disorder: childhood temper tantrums
- Premenstrual dysphoric disorder: disruption prior to/and during menstruation
What are the behavioural characteristics of depression?
- Activity levels: could result in psychomotor agitation (can’t stay still) or low energy
- Changes in sleeping and eating behaviour
- Aggression and self-harm
What are the emotional characteristics of depression?
- Lowered mood: feeling worthless and empty
- Low self-esteem
- Anger
What are the cognitive characteristics of depression?
- Absolutist thinking: also called ‘black and white thinking’
- Poor concentration
- Selective attention to negative events
What is Ellis’ ABC model?
(define irrational beliefs)
A - Activating event: We get depressed when we experience negative external events and these trigger irrational beliefs
B - Beliefs: Irrational thoughts are any thoughts which interfere with us being happy and free from pain
C - Consequence: Emotional (depression) and behavioural consequences
What is Beck’s cognitive therapy?
- Aims to identify the automatic thoughts about the world, the self, and the future (negative triad) -> once identified these thoughts must be challenged
- Also aims to help clients test the reality of their negative beliefs -> known as the ‘client as the scientist’, investigating the reality of their negative belief
What is the difference between reactive and endogenous depression?
Reactive: depression triggered by negative life events (activating events)
Endogenous: not traceable to life events and it isn’t obvious to what leads to the person becoming depressed
What is REBT?
- Extends the ABC model to ABCDE - Dispute and Effects -> identifies + disputes irrational thoughts
- Rational emotive behavioral therapy: the idea that by vigorously arguing with the depressed person, the therapist can alter the irrational beliefs that are making the person unhappy
What did Beck believe about depression?
- Some people are more vulnerable to depression than others - a persons cognitions create this vulnerability (cognitive vulnerability) and it has 3 parts:
- Faulty information processing: when depressed people attend to the negative aspects of a situation and ignore positives
- Negative self-schema: interpreting all information about themselves negatively
- Negative triad
What are cognitive vulnerabilities?
Ways of thinking that may predispose a person to becoming depressed, e.g. faulty information processing, negative self-schema, and the cognitive triad
What is Beck’s negative triad
- Suggested that a person develops a dysfunctional view of themselves because of 3 types of negative thinking that occur automatically, regardless of the reality of what’s happening at the time:
a) Negative view of the world
b) Negative view of the future
c) Negative view of the self
What evidence did Clark & Beck and Cohen et al provide about the cognitive explanation of depression?
- Clark & Beck concluded that not only were these cognitive vulnerabilities more common in depressed
people but they preceded the depression - Confirmed in a more recent prospective study by Cohen et al - tracked the development of 473 adolescents, regularly measuring cognitive vulnerability -> found that showing cognitive vulnerability predicted later depression
What are the weaknesses of Ellis’ cognitive explanation of depression?
- Partial explanation: only explains reactive not endogenous depression - no doubt that depression is triggered by life events (reactive) and how we respond to them is a result of our beliefs - some cases of depression aren’t traceable to life events (endogenous)
- Ethical issues: controversial model as it locates responsibility for depression purely with the depressed person - critics say this is blaming the depressed person (unfair)
- Reliance on self report measures: self report questionnaires to assess beliefs
- Overemphasis on Cognition = Reductionist: focuses on cognitive factors while neglecting other influences, e.g.
Biological factors (e.g., genetic predispositions), social/environmental factors (e.g. trauma) -> doesn’t fully capture the complexity of emotional disorders, limiting explanatory power
What is a strength of Ellis’ cognitive explanation of depression?
+ Real-world application: in the psychological treatment of depression - Ellis’ approach to cognitive therapy is REBT which is the idea that by vigorously arguing with the depressed person, the therapist can alter the irrational beliefs making them unhappy - some evidence to support the idea that REBT can both change negative beliefs and relieve symptoms of depression (David et al)
What is a strength of the cognitive treatments of depression?
- Research support: CBT was found to be just as effective as antidepressants (March et al - compared CBT to antidepressants + to a combination of both treatments when treating 327 depressed adolescents. After 36 weeks, 81% of CBT group, 81% of the antidepressants group & 86% of the CBT plus antidepressants group were significantly improved
What are the limitations of the cognitive treatment to depression?
- Suitability for diverse clients: ineffective for people with learning difficulties due to high cognitive load + in severe cases of depression (Stumey)
- Relapse rates: CBT doesn’t have long-lasting benefits - 42% within 6 months - (Ali et al) so may need to be repeated periodically
What study did March et al conduct about the effectiveness of CBT?
- A study of 327 adolescents comparing the effectiveness of CBT, antidepressants and a combination of both
- After 36 weeks, 81% of antidepressant group, 81% of CBT, and 86% of combination improved
What is CBT?
A method for treating mental disorders with both a cognitive & behavioural element
- Cognitive: assessment to clarify client’s problems, identify goals + put a plan together + identify irrational thought
- Behavioural: working to challenge irrational thoughts and put more effective behaviours into place
What did Stumey suggest about the cognitive treatment to depression for people with learning difficulties?
- Stumey suggested that psychotherapy of any kind is unsuitable for people with learning difficulties
What did Ali et al’s study show about cognitive treatments to depression?
- Ali et al assessed depression in 439 clients every month for 12 months following a course of CBT
- 42% relapsed after 6 months of ending treatment
What is the behavioural activation element of CBT?
- As individuals become depressed they tend to avoid difficult situations -> isolated -> maintains symptoms
- Behavioural activation aims to gradually decrease their avoidance & isolation & increase engagement in activities shown to increase mood e.g. going to dinner
What are the weaknesses of Beck’s cognitive explanation of depression?
- Only a partial explanation: cognitive vulnerability explains why depressed people show particular patterns of cognition before the onset of depression - some aspects of depression aren’t well explained by cognitive explanations e.g. some depressed people feel extreme anger, some experience hallucinations
- Reductionist: focuses only on cognitive factors, ignoring biological influences - Zhang et al. (2005) found that low serotonin levels are linked to depression, suggesting a biological basis rather than purely cognitive causes
What are the strengths of Beck’s cognitive explanations of depression?
+ Research support: in a review Clark and Beck concluded that cognitve vulnerabilities were more common in depressed people and preceded the depression - more recently Cohen et al tracked development of 473 adolescents and found showing CV predicted later depression
+ Real-world application: to screening & treatment for depression - Cohen et al concluded that assessing cognitive vulnerability allows psychologists to identify young people most at risk & understanding CV can be applied to CBT which alters the cognitions that make people vulnerable to depression
What is OCD?
- A condition characterised by obsessions and/or compulsive behaviour
- Obsessions are cognitive whereas obsessions are behavioural
What are the behavioural characteristics of OCD?
- Compulsions are repetitive: people with OCD are compelled to repeat a behaviour
- Compulsions reduce anxiety: compulsive behaviours are performed in attempt to manage the anxiety produced by the obsessions
- Avoidance: people with OCD tend to try to manage their OCD by avoiding situations that trigger anxiety
What are the emotional characteristics of OCD?
- Anxiety and distress: obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be frightening - the urge to repeat a behaviour (compulsion) creates anxiety
- Accompanying depression: OCD is often accompanied by depression so anxiety can be accompanied by low mood and lack of enjoyment in activities
Guilt and disgust: OCD sometimes involves irrational guilt or disgust which may be directed against something external or the self
What are the cognitive characteristics of OCD?
- Obsessive thoughts: thoughts that recur over and over again - vary from person to person but are always unpleasant
- Cognitive coping strategies: help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks
- Insight into excessive anxiety: experience catastrophic thoughts about the worse case scenarios that might result if their anxieties were justified
What are the 3 genetic explanations of OCD?
- Candidate genes
- OCD is polygenic
- Different types of OCD
What are candidate genes? Give an example.
- Genes which create vulnerability for OCD
- Some of these genes are involved in regulating development of the serotonin system
- For example, the gene 5HT1-D beta is implicated in the transport of serotonin across synapses
What does OCD being polygenic mean?
Which study is associated with this?
- OCD is not caused by one single gene but by a combination of genetic variations that together significantly increase vulnerability
- Taylor (2013) found evidence that up to 230 different genes may be involved in OCD
What is the ‘different types of OCD’ genetic explanation?
- Aetiologically heterogenous: one group of genes may cause OCD in one person but a different group cause the disorder in another person
- Also some evidence to suggest that different types of OCD may be the result of particular genetic variations e.g. hoarding disorder and religious obsession
What did Lewis’ study suggest about genetic vulnerablity?
- Of his OCD patients, 37% had OCD parents
- OCD runs in families - passes on genetic vulnerability
What is the diathesis-stress model?
Certain genes leave some people more likely to develop a mental disorder but it’s not certain - some environmental stress is necessary to trigger the condition
What evidence does Nestadt et al provide for the genetic explanation of OCD?
They reviewed twin studies and found that 68% of identical twins (MZ) shared OCD as opposed to 31% of non-identical (DZ) twins
What evidence did Cromer et al provide against the genetic explanation of OCD?
- They found that over half the OCD clients in their sample had experienced a traumatic event in
their past - OCD was also more severe in those with one or more traumas.
What are the 2 neural explanations of OCD?
- The role of serotonin
- Decision-making systems
What is ‘the role of serotonin’ explanation for OCD?
- Concerns the role of the neurotransmitter serotonin - helps regulate mood
- If a person has low levels of serotonin, normal transmission of mood-relevant info doesn’t take place - person may experience low moods
What are neurotransmitters?
Neurotransmitters are responsible for relaying information from one neuron to another
What is the ‘decision-making systems’ neural explanation of OCD?
- Some cases of OCD, particularly hoarding disorder, seem to be associated with impaired decision-making
- Also associated with abnormal functioning of lateral of the frontal lobes
- Evidence to suggest that an area called the left parahippocampal gyrus, associated with processing unpleasant emotions, functions abnormally in OCD
What is the left parahippocampal gyrus’ role in OCD?(neural explanation)
- There is some evidence to suggest the left parahippocampal gyrus, associated with processing unpleasant emotions, functions abnormally in OCD
What is a strength of the genetic explanations of OCD?
- Research support: evidence from a range of sources which suggest some people are vulnerable to OCD due to their genetic makeup
- Nestadt et al twin studies (2010) found 68% of MZ twins shared OCD
- Marini & Stebnicki (2012) found that a person with an OCD family member were 4 times more likely to develop it
What are the weaknesses of the genetic explanations of OCD?
- Environmental risk factors: strong evidence for the idea that genetic variation can make a person more/less vulnerable but OCD isn’t entirely genetic in origin - environmental risk factors can trigger OCD - Cromer et al (2007) found that over half the OCD clients had a past traumatic event = partial explanation
- Animal studies: mice and human share most genes but the human mind and brain are much more complex - not possible to generalise from animal repetitive behaviour to human OCD
- Biological determinism: genetic explanations imply that individuals with certain genetic predispositions are “destined” to develop OCD -> ignores personal agency & environmental influences, potentially leading to fatalistic attitudes or stigmatization
- Limited generalisability from twin studies: commonly used to estimate the heritability of OCD, but have limitations: MZ twins share 100% of their genes and often similar environments - hard to separate genetic influence from shared environmental factors + twin studies often rely on small, unrepresentative samples
What is a strength of the neural explanations to OCD?
- Research support: antidepressants that work purely on serotonin are effective in reducing OCD symptoms, suggests serotonin may be involved in OCD - Soomro et al’s review of 17 studies (symptoms reduced for 70% of people)
- OCD symptoms form part of conditions that are known to be biological in origin e.g. Parkinson’s disease causing paralysis (Nestadt et al. 2010)
- If a biological disorder produces OCD symptoms, then we may assume the biological processes underlie OCD - biological factors may be responsible for OCD
- Real-world application: led to the development of biological treatments, like SSRIs, which target serotonin imbalances -> increases the practical value of the explanation, as it informs effective drug therapy
What is the evidence for the benefits of drug therapy and who conducted the study?
- Soomro et al reviewed 17 studies on the use of SSRIs with OCD patients
- He found them to be more effective than placebos in reducing the symptoms of OCD up to 3 months after treatment
What are the weaknesses of the neural explanations of OCD?
- No unique neural system: serotonin-OCD link may not be unique to OCD - many people with OCD also experience clinical depression (co-morbid) + depression involves disruption to the action of serotonin - could be that serotonin activity is disrupted in many people with OCD as they’re also depressed - serotonin may not be relevant to OCD symptoms
- Correlation and causality: although some neural systems don’t work normally in people with OCD, this is a correlation between neural abnormality & OCD - doesn’t indicate a causal relationship, possible that the OCD causes the abnormal brain function or both influenced by 3rd factor
- Biologically reductionist: focuses solely on brain structures & neurotransmitter imbalances - oversimplifies a complex disorder like OCD, which involves interactions between biological, psychological, & environmental factors - less holistic
What does drug therapy do?
Aims to increase/decrease the levels of neurotransmitters in the brain
How do SSRIs work?
- By preventing the reabsorption and breakdown of serotonin, SSRIs increase levels of serotonin in the synapse so continue to stimulate the post-synaptic neuron
- Compensates for whatever is wrong with the serotonin system in OCD
How does the serotonin system work in the brain?
- Serotonin is released by pre-synaptic neuron & travels across a synapse
- Neurotransmitter chemically conveys a signal from pre- to post-synaptic neuron
- Then reabsorbed by the pre-synaptic neuron where its broken down and reused
What is the effect of combining SSRIs with other treatments?
- Drugs are often used alongside CBT
- Drugs reduce the emotional symptoms (anxiety, depression)
- OCD client can engage more effectively with CBT
What are the alternatives to SSRIs?
- Tricyclics
- SNRIs
What are the weaknesses of the biological treatments to OCD?
- Serious side-effects: can be distressing and sometimes long-lasting e.g. blurred vision, indigestion - for those taking tricyclic clomipramine side effects are even more common (1 in 10 experience weight gain) -> some people have a reduced quality of life as a result of taking drugs so may stop taking them altogether - drugs cease to be effective
- Individual differences in effectiveness: not all patients respond well to drug treatments, as OCD may have different causes (e.g., biological vs. cognitive) - Taylor (2013) found that different types of OCD may be linked to different genes -> one-size-fits-all approach is ineffective
What are the strengths of the biological treatments to OCD?
- Evidence of effectiveness: evidence to show that SSRIs reduce symptom severity and improve the quality of life for people with OCD (Soomro et al: reviewed 17 studies - reduction in symptoms for 70% compared to placebo) - helpful
- Cost-effective: cheap compared to psychological treatments - many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy - good value for public health systems like NHS
