Psychopathology Flashcards
1
Q
What affects abnormality
A
your subjective opinions, the culture you live in, the norms where you live or who you live with.
2
Q
Methods of defining abnormalities
A
- Statistical deviation
- Deviation from social norms
- Failure to function adequately 4. Deviation from ideal mental health
3
Q
Statistical deviation
A
Occurs when a person has a less common characteristic than most of the population e.g. being more depressed or have less intelligence
This uses the STANDARD DEVIATION and DISTRIBUTION – to what extent does a person’s characteristics deviate from the norm.
4
Q
Limitations of statistical deviation
A
Fails to distinguish between desirable and undesirable behaviour. Statistically speaking, many very gifted individuals could be classified as ‘abnormal’ using this definition.
Some characteristics are regarded as abnormal even though they are quite frequent.
Depression affects 1 in 5 elderly people- makes it common but does not mea n it isn’t a problem
5
Q
Evaluation of statistical deviation
A
Real life application - Strength
Statistical deviation is a useful part of clinical diagnosis so it therefore applicable to real life – e.g. the IQ distribution is a representative of the real population – in fact, most disorders have some sort of statistical measurement.
Unusual characteristics could be positive!
Statistical deviation is useless when the “abnormality” is a good thing e.g. an IQ of 130!
This is statistically abnormal but not clinically a bad thing!
6
Q
Evaluation of Statistical Deviat
A
Labelling – does not always benefit the individual
Meet Dave.
Dave is a happy, kind man who leads a functional and fulfilled life. He is 40 years old and works in a supermarket stacking shelves and keeping all the trollies in order. He lives with his mother in a two bedroom flat and has never left home. He has an IQ of 56.
Should we diagnose Dave with Intellectual Disability Disorder? It will involve someone telling Dave he has a disorder and on his record
7
Q
Evaluation of Statistical Deviati
A
Labelling – does not always benefit the individual
Labelling is powerful and might affect people in a negative way. If you give people a label, they might start acting in a way that fulfils the label.
Some people are “abnormal” but lead happy and fulfilled lives. If we label someone then we run the risk of developing a self fulfilling prophecy
8
Q
failure to function adequately
A
cross the line between normal to abnormal at any point when they can no longer cope with the demands of everyday life.
Therefore they fail to function adequately.
9
Q
examples to not functioning adequately
A
Unable to meet basic standards of nutrition
Cannot hold down a job
Cannot maintain relationships
Unable to meet basic standards of hygiene
10
Q
rosenhan and selignan
A
proposed the following signs that can be used to determine whether someone is coping or not.
no longer conforms to standard interpersonal rules
When a person experiences severe personal distress (themselves) or causes distress and discomfort to others.
behaviour is unpredictable and sometimes uncontrolled
behaviour is irrational and hard to understand
Maladaptiveness – the behaviour interferes with a person’s usual daily routine – goes against their long term interests
10
Q
Strength of FFA
A
Represents a threshold for help
One strength of FFA is that it provides a criterion for when people need professional help. Most of us have symptoms of mental disorder to some extent at some point in time
Mind – around 25% of people in the UK will experience a mental health problem in any given year
However, many people continue to work despite of these symptoms. It tends to be when we cease to function adequately is when we need to seek professional help.
So this criterion means that treatment and services can be specifically targeted to those who need it the most
11
Q
weakness of FFA
A
n practice it can be hard to say when someone is failing top function adequately and when they are simply just deviating from social norms. We might see new age travellers as failing to function adequately but what if its just an alternative lifestyle? Similarly base jumpers might be seen as having a maladaptive lifestyle and spiritualists – irrational. If we class these as FFA, then we risk limiting personal freedom and discriminating against minority groups
12
Q
group eg ,New Age traveller
A
Do not live in permanent accommodation and may not work
13
Q
group eg. base jumpers
A
Take part in extreme sports with a high mortality rate
14
Q
group eg.spirtuality
A
take part in religious rituals believing they are communicating with the dead
15
Q
limitations of ffa
A
Having a Psychological Disorder
may not result in FFA.
People often maintain adequate function
when facing anxiety or depression.
People with personality disorders can appear
perfectly normal most of the time.
- Cultural Relativity is a key issue of FFA. Standard patterns of behaviour vary from culture to culture, so FFA may look different depending upon which culture you are in.
It is easy to label non-standard lifestyle choices as abnormal, but they may have simply chosen to deviate from social norms – new age travellers
16
Q
good mental health
A
high self-esteem and a strong sense of identity are related to good mental health. According to Jahoda, to be mentally healthy, someone must know who they are and like what they see. Free from guilt
extent of a person’s self-development or progress towards Self-Actualisation.
autonomy - the extent to which an individual is free of social influences – independent of other people
We have no symptoms or distress
We can cope with stress
17
Q
evaluation of dimh
A
Cultural relativism:
Jahoda’s characteristics are rooted in Western societies and are therefore culture bound. – For example, the focus on personal achievement characterised by self actualisation is not the case in collectivist cultures which would instead be considered self-indulgent and they would rather focus on community rather than autonomy and the self– cultural relativity
- It sets an unrealistically high standard for ideal mental health!
Very few people actually match the Jahoda’s criteria and probably none of us will achieve them all at the same time or be able to keep them up for very long. So by definition the majority of the population would be classified as abnormal. Thus its unclear how far a person could
deviate before being defined as abnormal.
On the positive side, it makes clear to people the positives of seeking help – such as counselling to improve mental health
18
Q
Phobias
A
anxiety disorder. An irrational fear of an object or situation which can interfere with daily living.
19
Q
How phobias are diagnosed
A
The dsm-5
diagnosing mental disorders
updated every so often as ideas about abnormalities change. We are currently on the 5th edition of the DSM hence the -5 (2013)
20
Q
What are phobias categorised by
A
excessive fear and anxiety triggered by a place, situation or object. This anxiety is is out of proportion by any danger presented by the phobic stimulus.
3 categories:
21
Q
Three types of phobias
A
1)agoraphobia
2)social phobias
3)specific phobias
22
Q
Agoraphobia
A
Fear of open space beings outside or in public spaces
23
Q
Social phobias
A
Fear of interacting or having social interactions ,public speaking ,using public toilet
24
Specific phobias
Fear of a specific object animal or situations such as flying or an injection
25
Behavioural characteristics of phobias
Panic
Avoidance
Endurance
26
Panic
display panic in response to or in the presence of the phobic stimulus.
crying, screaming, running away, biting nail
freeze, cling to their parent or throw a tantrum.
27
Avoidance
a lot of effort to avoid coming into contact with their phobic stimulu
someone who has a phobia of public toilets may limit the time they can stay outside based off of how long they can hold off using the toilet.
28
Endurance
The alternative to avoidance is endurance, in which the person remains in the presence of the phobic stimulus but continues to experience high levels of anxiety. This may be unavoidable in some instances – such as a person with a fear of flying or social interaction
29
Emotional characteristics of phobias
unpleasant state of high arousal
prevents the sufferer from relaxing or experiencing any positive emotions in the presence of the phobic stimulu
Fear is the immediate response we feel in the presence of the stimulus
30
Arachnophobia
Arachnophobia: fear of spiders – anxiety will increase when you enter any place associated with a spider – zoo, gardens, garden shed. The fear is the immediate response when he actually sees a spider.
Emotional responses are unreasonable, excessive and disproportionate to the danger posed.
31
Cognitive characteristics of phobias
1)selective attention to the phobic stimulus
2)irrational fear
3)cognitive distortions
32
Selective attention to the phobic stimulus
Keeping our attention on something that can harm us or can pose a danger to us can be a good thing as it gives us the best chance to respond to a threat quickly, but this is not so useful when the fear is irrational.
33
Irrational fear
irrational beliefs in relation to the phobic stimulus. For example, a person with social phobias may have beliefs like ‘I must always sound intelligent’ or ‘if I blush they’ll think I’m weak.’ This can add a lot of pressure on the sufferer to perform well in public situations.
34
Cognitive distortions
The phobics perception of the phobic stimulus may be distorted. For example, someone with a fear of spiders – may see spiders as disgusting, ugly and huge. Someone with a fear of belly buttons may see them as ugly/disgusting.
35
Outline characteristics of phobic disorders
One characteristic of a Phobic disorder is avoidance which Rita displays. Avoidance is when someone takes a lot of effort into staying away from their phobic stimuli here Rita doesn’t go to her friends house anymore as her friend now has two doffs and on top of that she also doesn’t leave the house if she sees a dog on the street
Another characteristic of phobic disorders is panic
36
Systematic desensitisation
behavioural therapy designed to gradually reduce phobic anxiety using the principle of classical conditioning.
The idea is that if the sufferer can learn to relax in the presence of the phobic stimulus, they will be cured.
Systematic desensitization uses counter conditioning to unlearn the maladaptive response to a situation or phobic stimulus such as anxiety by replacing it with relaxation
A new response is learned to the phobic stimulus -> counter conditioning
It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is known as reciprocal inhibition.
37
Three processes of systematic desensitisation
1)anxiety hierarchy
2)relaxation
3)exposure
38
Anxiety hierarchy
Put together by patient and therapist together
List of situations relating to the phobia stimulus that provoke anxiety arranged in order from least to most frightening
39
Relaxation
Therapist teaches the patient to relax using breathing techniques or meditation. They may also teach them mental imagery techniques, where the patient is taught to imagine themselves in pleasant situations such as being on the beach in the sun. Might also include drug therapy - valium
• Used throughout the anxiety hierarchy - aimed to reduce the anxiety in each stage. Patient may go back a stage if they find current stage too stressful.
• Further relaxation techniques are employed to help them move to the next step e.g. meditation
40
Exposure
Finally in the last step, the patient is exposed to the phobic stimulus whilst in the relaxed state. This typically takes place across several sessions. According to SD, both fear and relaxation cannot be present at the same time (reciprocal inhibition), therefore, relaxation should take over the fear.
The patient starts of at the lowest level of the anxiety hierarchy, once they are relaxed in their lowest level, they then continue to work their way up the anxiety hierarchy until they are relaxed in the most feared situation.
At this point, systematic Desensitisation is successful and a new response to the stimulus has been learnt, replacing the phobia
41
E valuation of treatment for phobias -systematic desensitisation
P:One strength of systematic desensitisation comes from research evidence that demonstrates the effectiveness of this treatment for phobias.
E:McGrath et al. (1990) found that 75% of patients with phobias were successful ly treated using systematic desensitisation.
E:This was particularly true when using in vivo techniques in which the patient c ame into direct contact with the feared stimulus rather than simply imagining (in
vitro)
L:This shows that systematic desensitisation is effective when treating specific p hobias, especially when using in vivo techniques
42
Evaluation of treatment for phobias -systematic desensitisation
P:Further support comes from Gilroy et al. (2002) who examined 42 patients with ar achnophobia (fear of spiders).
E:Each patient was treated using three 45‐minute systematic desensitisation session s. When examined three months and 33 months later, the systematic desensitisation group were less fearful than a control group (who were only taught relaxation techn
iques).
E:The experimental group showed less fear compared to the control group
L:This provides further support for systematic desensitisation as an effective treatm ent for phobias in the long‐term
43
Limitation of systematic desensitisation
P:However, a limitation of systematic desensitisation is that it is not effective in treating all phobias
E:Patients with phobias which have not developed through a personal exper ience (classical conditioning), such as a fear of snakes, are
not effectively treated using systematic desensitisation
E:Some psychologists believe that certain phobias have an evolutionary surv ival benefit and are not the result of learning
L:This highlights a limitation of systematic desensitisation, which is ineffectiv e in treating evolutionary phobias which have an innate basi
44
Flooding
Involves exposing the phobic patient to their phobic stimulus but without the buildup of the anxiety hierarchy (still taught relaxation techniques)
Flooding involves inescapable exposure to the feared object or situation that lasts until the fear response disappears –e.g. someone who has claustrophobia might be shut into a small room for at least an hour or until their initial high levels of anxiety reduce.
The procedure assumes that very high levels of fear and anxiety cannot be sustained and will eventually fall.
This intense exposure is done longer sessions, with sessions lasting around two to three hours in a controlled and safe manner. Sometimes only one long sesson is only needed.
With flooding, a person is unable to negatively reinforce – avoid their phobic stimulus and through continuous exposure, the anxiety eventually decreases
Since the option of employing avoidant behaviour is removed, extinction occurs sin ce fear is a time‐limited response to a situation which eventually subsides. As exhau stion sets in for the individual they may begin to feel a sense of calm and relief which creates a new positive association to the stimulus as they realise the phobic stimulus cannot harm them.
45
Extinction
since fear is a time‐limited response to a situation which eventually sub sides. As exhaustion sets in for the individual they may begin to feel a sense of calm and relief which creates a new positive association to the stimulus as they realise the phobic stimulus cannot harm them.
A learned response is extinguished when the conditioned stimulus such as a spider is encountered without the unconditioned stimulus – being bitten, which results in no conditioned response – f
46
Ethical issues of flooding
Flooding is not unethical per say but it does create an unpleasant experience for the patient and so acquiring informed consent is essential to make sure they are fully aware and prepared for the experience. Patients are usually given the choice between SD and flooding
47
Evaluation of phobias
P:One strength of flooding is it provides a cost‐effective treatment for phobia
s.
E:Research has suggested that flooding is equally effective to other treatme nts, including systematic desensitisation and cognition therapies (Ougrin, 20 11)
E: It is equally as effective
but takes much less time in achieving these positive results.
L:Thisis astrengthofthetreatmentbecausepatientscuretheirphobiasmor e quickly and it is therefore more cost‐effective for health service providers who do not have to fund longer options.
48
Evaluation of phobias neg
P:Although flooding is considered a cost‐effective solution, it can be hi ghly traumatic for patients because
flooding purposefully elicits a high level of anxiety
E:Wolpe (1969) recalled a case with a patient becoming so intensely a nxious that she required hospitalisation.
E:Although it is not unethical as patients provide fully informed conse nt, many do not complete their treatment because the experience is to o stressful.
L:Therefore, initiating flooding treatment is sometimes a waste of time and money if patients do not engage in or complete the full course of
their treatment.
49
Dsm5 and ocd
recognises OCD. What these disorders all have in common is repetitive behaviour accompanied by obsessive thinkin
50
What ocd his described as
charecterised by either obsessions (recurring thoughts, images etc.) and/or compulsions (repetitive behaviours such as hand washing). Most people with a diagnosis of OCD have both obsessions and compulsions
51
Trichotillomania
Compulsive hair pulling
52
Hoarding disorder
the compulsive gathering of material objects and the inability to part with anything regardless of its importance or value
53
Excoriation disorder
Compulsive skin picking
54
Behavioural characteristics of ocd
Compulsions
55
What are compulsions
The behavioural component of OCD is compulsive behaviour. There are two elements to compulsive behaviours
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Compulsions being repetitive
Typically sufferers of OCD feel compelled to repeat a behaviour. A common and popular example of this is hand washing. Other common compulsive repetitions may include counting, praying, tidying or ordering items
57
Compulsions reducing anxiety
Around 10% of people who suffer from OCD show compulsive behaviour alone – they have no obsession, just a general sense of irrational anxiety. However, for the vast majority of individuals who suffer from OCD, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions
58
Example of compulsion
hand washing (repetitive hand washing) is carried out as a response to and obsessive fear of germs and dirt. Compulsive checking for example that the door is locked or that your appliances like hair straighteners are switched off is carried out in response to the obsessive though that it might be left unsecured
59
Behavioural characteristics
Avoidance and compulsions
60
Avoidance
The behaviour of OCD sufferers may also be characterised by their avoidance as
they attempt to reduce anxiety by staying away from the situations that trigger it.
For example, sufferers who wash compulsively may avoid coming into contact with germs – going outside, using public toilets, drinking from cups/glasses at a friends house.
However this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish bins, going out – and so can interfere with normal life
61
Emotional Characteristics of OCD
Anxiety and distress:
OCD is regarded as an unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts can be both unpleasant and frightening for the individual – having thoughts such as your family will die if you don’t switch off the lights 50 times. The anxiety this produces can be overwhelming for individuals. The urge to repeat these behaviours (compulsions) can create anxiety.
Accompanying Depression:
OCD is often linked with depression, so anxiety can be accompanied with low mood and lack of enjoyment in usual activities. Compulsive behaviour tends to bring some relief from the anxiety but this is only temporary.
Guilt and Disgust:
Individuals who suffer from OCD may experience, anxiety, depression but also other negative emotions such as irrational guilt, for example over minor moral issues or disgust which may be directed at something external such as dirt or germs but also at the self
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Cognitive Characteristics of OCD
Obsessive thoughts:
Around 90% of individuals who suffer from OCD also experience obsessive thoughts – thoughts that recur over and over again. These obsessive thoughts vary largely from person to person but are always unpleasant. For example, a recurring thought may be worry about being contaminated by dirt or germs or constant worry that the door has been left open and an intruder will enter or you’ve left an appliance turned on and everything will burn down.
Cognitive strategies to deal with obsessions:
Obsessions are the major cognitive aspect of OCD but people also respond by developing cognitive coping strategies to help them deal with the anxiety that occurs from obsessive thoughts. For example a religious person tormented by obsessive guilt may respond by praying or meditating. This may help the individual manage their anxiety but make the person appear abnormal to others and may distract from everyday tasks
Insight into excessive anxiety:
People who suffer with OCD are aware that their obsessions and compulsions are irrational. In fact, this is actually a necessary facet in order to be diagnosed with OCD. If someone really believed their obsessive thoughts were based on reality that would be a symptom of a different form of mental disorder. It is therefore important that the individual is aware that their obsessions and compulsions are irrational.
However, although individuals are aware they often experience catastrophic thoughts about the worst case scenarios which might result if their anxieties were justified.
They also tend to be hypervilgilant – maintain constant alertness and keep attention focused on potential hazards
63
The cycle of ocd
Obsessive thought
Anxiety
Compulsive behaviour
Temporarily revlif
Obsessive thought
64
Biological approach of ocd
The biological approach to explaining OCD addresses both genetic and neural explanations.
Genetic explanations suggest that OCD is inherited and that individuals receive specific genes from their parents which influence the onset of OCD
Neural explanations suggest that abnormal levels of neurotransmitters and certain regions of the brain are implicated in OCD
65
Genetic explanations of ocd
It has been proposed that there is a genetic component to OCD which predisposes some individuals to the illness.
• This may explain why patients often have other family members with OCD.
• Lewis (1936) observed that of his OCD patients 37% had parents with OCD and 21% had siblings with OCD. This suggests that OCD runs in families although what is passed on from one generation to another is probably the genetic vulnerability rather than the certainty of OCD
• According to the diathesis-stress model certain genes leave some people more likely to suffer a mental disorder but it is not certain – some environmental stress is required to trigger the onset of the condition
66
Discuss the genetic explanation for obsessive compulsive disorder
-Genetic explanations have focused on identifying specific candidate genes which are implicated in OCD. It is believed that OCD is a polygenic condition, which means that several genes are involved..
-Two examples of genes that have been linked to OCD are the COMT gene and SERT gene. The COMT gene is associated with the production of catechol‐O‐methyltransferase (COMT for short), which regulates the neurotransmitter dopamine. Althoughall genes come in different forms, one variation of the COMT gene results in higher levels of dopamine and this variation is more common in patients with OCD, compared to people without OCD.
67
Drug therapy
Is the most commonly used biological therapy for anxiety disorders
• Assumes that there is a chemical imbalance in the brain
• This can be corrected by drugs, which either increase or decrease the levels of neurotransmitters in the brain.
68
Ssris
• The standard medical treatment used to tackle the symptoms of OCD involves a particular type of antidepressant drug called SSRIs – these are considered the first-line treatment for OCD
• SSRIs work on increasing certain neurotransmitter (serotonin) in the brain
• serotonin is usually reabsorbed by the nerve cells (known as "reuptake"). SSRIs work by inhibiting
reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells and increases the amount of serotonin in the synapse
69
Before ssri treatment
• Presynaptic neuron releases serotonin
• Serotonin travels across the synapse passing through the presynaptic neuron to
the postsynaptic neuron
• Serotonin is then reabsorbed by the presynaptic neuron where it is broken down and reabsorbed
- Serotonin remains low
70
After ssri treatment
• Presynaptic neuron releases serotonin
• Serotonin travels across the synapse passing through the presynaptic neuron to
the postsynaptic neuron
• SSRI stops the reabsorption and break down of serotonin
• More serotonin in the synapse and therefore continues to stimulate the postsynaptic neuron
- Serotonin levels increase
71
What do ssris do
SSRIs block the reuptake and reabsorption of serotonin thus increasing the amount of serotonin in the synapse
72
How do ssri work
When serotonin is released from the presynaptic neuron in the brain and travels across the synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron. It is then reabsorbed by the presynaptic neuron where it is broken down and reused. SSRIs work by increasing the levels of serotonin in the synapse by blocking the reuptake of serotonin by the presynaptic neuron. This means serotonin is not broken down and there is more serotonin in the synapse allowing it to continue to stimulate the postsynaptic neuron.
This then compensates for what may be wrong with the serotonin system in OCD.
73
Example of drug therapy
• Dosage and other advice vary according to which SSRI is prescribed. Some people may respond better to one type of SSRI compared to another and so each persons circumstance is uniquely considered before being prescribed.
• A typical daily dose of fluoxetine is 20mg although this can be increased if it is not benefitting the person. The drug is available as either capsules or liquid. It takes three to four months of daily use of SSRIs to have an impact on symptoms.
• Other SSRIs include Sertraline and Escitalopram
74
Combining ssri with other treatments
• Drugs are often used alongside Cognitive Behavioural Therapy (CBT) to treat OCD. The drugs reduce the persons emotional symptoms, such as feeling anxious or depressed.
• This means that as a result, people with OCD are more effectively engaged with CBT.
• In practice, some people respond best to CBT alone whilst others benefit more when additionally using drugs such as fluoxetine. Occasionally other drugs can also be prescribed alongside SSRIs.
75
Alternative to ssris
When an SSRI is not effect9ive after three to four months the dose can be increased (e.g. 60mg of fluoxetine) or it can be combined with other drugs. Sometimes different antidepressants may be tried. People respond differently to different drugs and alternatives work well for some people and not at all for others
Tricyclics -(older antidepressant – E.G. Clomipramine)
Considered first generation antidepressants – work in the similar way as SSRI (reuptake inhibition leaving higher concentration of serotonin.) However, because these drugs have more side effects (such as urinary retention, constipation, dizziness) than SSRIs so it is generally kept in reserve for people who do not respond to SSRIs.
SNRIs– Serotonin-noradrenaline reuptake inhibitor
Have more recently been used to treat OCD. These are a different class of antidepressant drugs and like clomipramine are a second line of defence for people who do not respond to SSRIs.
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Strengths of drug therapy
One strength of biological treatments for OCD comes from research support for their e ffectiveness.
An advantage to biological treatments for OCD is their cost effectiveness.
77
Limitation of drug therapy
A limitation of prescribing drug treatments for OCD is the possible side effects of drugs like SSRIs.
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 (2016) conducted a systematic review of outcome studies and found that both cognitive and behavioural treatments (exposure) might be more effective than SSRIs in the treatment of OCD.
78
Eclectic approach
An eclectic approach appears to be the most effective
This is most likely due to the combined impact of drugs – tackling the feelings of anxiety and depression – and CBT – replacing the unwanted thoughts and changing behavioural habits.
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Behavioural characteristics of depression
1. Activity levels:
Typically people who suffer from depression may experience reduced levels of energy often making them feel lethargic and constantly feeling tired. This has a knock on effect where sufferers tend to withdraw from work, education, social life (things that would usually make them happy). In some cases, the condition may be so severe the sufferer cannot get out of bed. In some cases, depression can lead to the opposite effect, where agitated individuals struggle to relax and may pace up and down a room. This is know as psychomotor agitation.
2. Disruption to sleep and eating behaviour:
Depression is associated with changes to sleeping behaviour. Sufferers may experience either reduced sleep (insomnia) or an increased need for sleep (hypersomnia). Similarly, sufferers appetite and eating may increase or decrease – leading to fluctuations in weight.
3. Aggression and self harm:
Sufferers of depression are often irritable and in some cases may be both verbally and physically aggressive. This can have knock-on effects for a persons life, for example, a sufferer may display verbal aggression by ending a relationship or quitting their job. Depression can also lead to physical harm against the self (self harm, often in the form of cutting or suicide attempts)
80
Emotional characteristics of depression
1. Lowered mood
The word ‘depressed’ in everyday life usually describes having a lowered mood or feeling sad. However, we are looking at depression in a more clinical sense. Lowered mood is still a defining emotional characteristic of depression but it is more pronounced In people with depression. Patients often describe themselves feeling ‘empty’ or ‘worthless’
2. Anger
Sufferers tend to experience more negative symptoms and fewer positive symptoms during episodes, however this feeling of negative emotions is not limited to sadness. Sufferers also often experience anger, sometimes extreme anger directed at themselves or others – these can lead to aggressive or self-harming behaviour.
3. Lowered self-esteem
Individuals who suffer from depression tend to report reduced self-esteem. This can be quite extreme with some sufferers nothing a sense of self-loathing (hating themselves).
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Two key cognitive theories which attempt to explain depression
-becks cognitive triad
-ellis abc model
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Becks cognitive theory of depression
suggested a cognitive approach to explaining why some people may be more vulnerable to depression than others. In particular, he highlighted that a person’s cognitions is what creates this vulnerability i.e. the way that they think.
Beck proposed three part to this cognitive vulnerability:
• Faulty Information Processing • Negative Self-schemas
• The Negative Triad
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Faulty information processing
When someone suffers from depression, they attend to the negative aspects of a situation and ignore the positives
For example; if I was depressed and won £1 million on the lottery, I might focus on the fact that the previous week someone had won £10 million rather than focus on the positives of everything I could do with £1 million.
People with depression also tend to blow small problems out of proportion and think in ‘black and white’ terms, often catastrophizing situations.
This leads to cognitive biases
84
Cognitive biases
Overgeneralisation
Catastrophisng
85
Overgeneralisations
may make a sweeping conclusion based on a single incident
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Catastrophising
exaggerate a minor setback and believe it’s a complete disaster
87
Negative self schemas
A schema is a ’package’ of knowledge which stores information and ideas about the world around us developed through experiences. 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.
According to Beck, these self-schemas develop during childhood and people with depression have a negative self-schema – which may be the result of negative experiences for example, constant criticism from parents, peers, teachers.
88
Examples of negative self schemas
• An ineptness schema – always expecting to fail
• A Self-blame scheme - makes them feel responsible for anything that goes wrong • A Negative self-evaluation schema – constant feelings of worthlessness
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Negative triad
A person develops a dysfunctional view of themselves because of three types of thinking which occur automatically – regardless of the reality. These three elements are called the negative triad. When we are depressed, we have negative thoughts about the world, the future and the self.
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What beck says about the negative triad
According to Beck, negative self‐schemas and cognitive biases maintain the negative triad which is a negative view of three key aspects of a person’s life which lead to depression. These include:
- The world – ‘The world is an unfair place.’
- The future – ‘I will always be a failure.’
- The self – ‘Nobody loves me.’
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Evaluation of becks negative processing
There is a range of evidence to support the idea that depression is associated with faulty information processing, negative self schemas and the cognitive triad
Grazioli and Terry (2000) 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 from post-natal depression
Beck (1990) concluded there was solid support for all these cognitive vulnerability factors. Critically, these cognitions can be seen BEFORE depression develops. Suggesting that Beck may be right about cognitions causing depression
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Evaluation of becks negative triad
One strength of the cognitive explanation for depression is its application to therapy
Cognitive explanations have been used to develop effective treatments for depression, including Cognitive Behavioural Therapy (CBT), and Rational Emotive Behaviour Therapy (REBT) which was developed from Ellis’s ABC model.
E: These therapies attempt to identify and challenge negative, irrational thoughts and have been successfully used to treat people with depression.
L: This provides further support to the cognitive explanation of depression.
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Evaluation of Beck’s Negative Triad
It doesn’t explain all aspects of depression
Some depressed patients are deeply angry and Beck cannot easily explain this extreme emotion
Some sufferers may also suffer from hallucinations and bizarre beliefs. Very occasionally depressed patients suffer Cotard syndrome, the delusion that they are zombies (Jarett 2013)
Beck’s theory cannot explain these cases, highlighting the complexity of depression
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Ellis abc model
Another American psychiatrist, Albert Ellis (1962) suggested a different cognitive explanation of depression. He suggested that good mental health is the result of rational thinking. Therefore, conditions such as anxiety and depression result from irrational thoughts.
Ellis defined irrational thoughts not as illogical or unrealistic thoughts but rather as any thought that interfered with us being happy and free of pain
Ellis used the ABC model to explain how irrational thoughts affect out behaviour and emotional state
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A in ellis model
activating event is when irrational thoughts are triggered by external events. According to Ellis we get depressed when we experience negative events and these trigger irrational beliefs
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B in ellis abc model
beliefs which is your interpretation of the event which results in either rational or irrational beliefs. Example: ‘musturbation’ – belief that we must always succeed or achieve perfection. ‘Utopianism’ - the idea that life is always meant to be fair
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C in Eli’s abc model
consequence
when an activating event triggers irrational beliefs
beliefs which is your interpretation of the event
(C) a
there are emotional and behavioural consequences. For example if you believe you must always succeed and then fail at something this can trigger depression
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Evaluation of abc model
One strength of the cognitive explanation for depression is its application to therapy.
Cognitive explanations have been used to develop effective treatments for depression, including Cognitive Behavioural Therapy (CBT), and Rational Emotive Behaviour Therapy (REBT) which was developed from Ellis’s ABC model.
E: These therapies attempt to identify and challenge negative, irrational thoughts and have been successfully used to treat people with depression.
L: This provides further support to the cognitive explanation of depression.
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Evaluation of Ellis abc model
Like Beck’s theory, Ellis’s explanation of depression may be an oversimplification of depression
Some depressed patients are deeply angry and Ellis cannot easily explain this extreme emotion
E: Some sufferers may also suffer from hallucinations and bizarre beliefs. Very occasionally depressed patients suffer Cotard syndrome, the delusion that they are zombies (Jarett 2013)
L: Ellis’s theory cannot explain these cases, highlighting the complexity of depression
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Evaluation of abc model
There are some cases of depression which follow activating events, but it cannot account for cases of depression which do not
Psychologists call depression which follows an activating event reactive depression and see it as different to the kind of depression that arises without an obvious cause
E: In this case, it might be more effective to look at potential alternative explanations of depression such as biological explanations which look at the neurochemical imbalances such as lack of serotonin which may cause depression.
L: This means that Ellis’s explanation only applies to some kinds of depression and is therefore only a partial explanation for depression
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Overall evaluation for elis and beck
• The cognitive explanation cannot account for the physical symptoms of mood disorders
• With depression these include aches and pains, a lack of energy, palpitations, headaches and stomach upsets. For women there may be menstrual changes. Sleep disturbance is another possible symptom. Sufferers can experience loss of appetite or weight.– how can irrational thought processes cause these symptoms?
• Is there an alternative explanation?
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CBT
Cognitive Behavioural Therapy (CBT) is the most commonly used psychological treatment for depression, if you see a psychologist for a mental health disorder you will most likely receive CBT.
• CBT involves both cognitive and behavioural elements. The cognitive element aims to identify irrational and negative thoughts, which lead to depression. The aim is then to replace these thoughts with more positive and rational ones. The behavioural element of CBT encourages patients to test their beliefs through behavioural experiments and homework
• The focus is on the present and the future not the past
• Some CBT therapists do this using techniques purely from Beck’s cognitive therapy, others solely use Ellis’s rational emotive behaviour therapy. Most will use parts of both.
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Two main therapies
a) Beck’s Cognitive Therapy for Depression
b) Ellis’s Rational Emotive behaviour Therapy (REBT)
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