Psychopathology 😘 Flashcards
Paper 1
1
Q
What is the definition of psychopathology?
A
- scientific study of psychological disorders/ mental illnesses
2
Q
what are the 4 definitions of abnormalities?
A
statistical infrequencies
deviation from social norms
failure to function adequately
deviation from ideal mental health
3
Q
what is statistical infrequency?
A
- defines ‘normal’/common behaviour in typical values
- i.e. mean, median and mode
- numbers based definition
- shown on a distribution curve (anything more than 2 standard deviations away from the mean may indicate an abnormality)
4
Q
what is an example of a statistical infrequency?
A
IQ
- average is 100, so anything above 130 and below 70 is seen as abnormal
5
Q
what are limitations of statistical infrequencies?
A
- some infrequent behaviours may be desireable (ie. high IQ) and some frequent behaviours may be undesireable (ie. depression), suggesting there is a problem with numbers based definitions
- subjective cut off on the normal distribution (ie. if 1 score above or below 2 standard deviations)
6
Q
what are the strengths of statistical infrequencies?
A
- appropriate for some diagnosis as it gives us an indication
- good objective starting point/ measure
- better to use with another definition: failure to function adequately
7
Q
what is the cultural relativism evaluation for statistical infrequencies?
A
- statistically frequent behaviours in one culture may be statistically infrequent in another
- for example, hearing voices in one may be associated with schizophrenia, but it may be desirable in another
8
Q
what is deviation from social norms?
A
- social norms = expected/ usual behaviour in a culture or society. implicit/ explicit rules that a society has about socially acceptable behaviours
- socially based explanation
- deviance from these social norms is undesirable, can often lead to rejection and is considered abnormal leading to isolation
9
Q
what is an example of deviating from social norms?
A
- standing too close to someone
- inappropriate dress for age or situation
10
Q
what are the limitations of deviation from social norms?
A
- role of context
- changes over time
11
Q
what are the strengths of deviation from social norms?
A
- focus is on social norms which helps a society to function
- considers the effect on others
12
Q
what is the cultural relativism evaluation for deviation from social norms?
A
- social norms vary ie. personal space
- dangers of being ethnocentric: not considering other cultural values or judging someone else based on our own cultural values
- DSM now makes reference to different cultural behaviours ie. panic attacks
13
Q
what is failure to function adequately?
A
- individual will feel psychological distress and unable to cope with usual everyday activities
- usually aware they are suffering but some may not be (identified by other people instead)
- measure of adequate functioning can be done by WHODAS included in DSM
14
Q
what does WHODAS do?
A
- gives a quantitative measure of adequate functioning
- individuals are rated from 1-5 and given a score per criteria (out of 180)
15
Q
what are the WHODAS criteria?
A
- understanding and communication
- getting around
- getting along with people
- self care
- life activities
- participation in society
16
Q
what are the strengths of failure to function adequately?
A
- provides an objective measure
- more sensitive definition
17
Q
what are the limitations of failure to function adequately?
A
- subjective judgement so it depends on who is making the decision
- behaviours may be functional to the individual (ie. cross dressing), doesnt distinguish between functional and non-functional behaviour
18
Q
what is the cultural relativism evaluation for failure to function adequately?
A
- what is considered dysfunctional in one culture may not be in the other
- ie. sleeping in the day may be normal in Mediterranean cultures but could be considered as depression in the UK
- risks being ethnocentric
19
Q
what is deviation from ideal mental health?
A
- based on humanistic approach, all have the ability to achieve full potential if given the correct conditions
- positivist definition (looks at characteristics individual needs to have present for maintaining optimal mental health)
- Marie Jahoda identified 6 categories relating to ideal mental health
20
Q
what categories did Jahoda identify?
A
- self attitude
- personal growth
- integration
- autonomy
- accurate perception of reality
- mastery of environment
21
Q
what are the strengths of deviation from ideal mental health?
A
- positivist approach
- looks at categories that give us good mental health and considers what is needed for it
22
Q
what are the limitation of deviation from ideal mental health?
A
- ideals are unrealistic (hard to achieve by nature)
- involves subjective assessment of Jahoda’s criteria, so its a matter of opinion and also hard to measure objectively
- difficult to diagnose mental ill-health and physical health in the same way
23
Q
what is the cultural relativity evaluation for deviation from ideal mental health?
A
- based on western values
- individualist cultures encourage working for one’s own personal good towards self actualisation
- collectivist cultures encourage working for the good of the community
- cultural context may limit this definition to certain cultural groups
24
Q
what are neurotic disorders?
A
- disorders an individual is self aware of (know they have it)
25
what are psychotic disorders?
- disorders an individual in unaware of (don't know they have it)
26
what are phobias?
- anxiety disorder
- irrational fear that causes avoidance of the feared stimuli
27
what are the emotional characteristics of phobias?
- extreme and persistent fear
- anxiety
- panic
28
what are the behavioural characteristics of phobias?
- avoidance
- freeze or faint stress response
29
what are the cognitive characteristics of phobias?
- irrational thinking
- resistance to rational reasoning
- recognition of irrational fear
30
what are some examples of phobias?
- agoraphobia
- social phobia
- specific phobia
31
what is depression?
- mood disorder
- may be 'major depressive disorder' or 'persistent depressive disorder'
- persistent low mood causing distress and impairment of functioning
- diagnosis requires minimum 5 of the symptoms
32
what are the emotional characteristics of depression?
- sadness
- feeling empty/ worthless
- loss of interest in usual activities
- anger towards others or self
33
what are the behavioural characteristics of depression?
- change in activity level (increased or decreased)
- change in sleep patterns (more or less)
- change in appetite (more or less)
34
what are the cognitive characteristics of depression?
- negative thoughts
- including worthlessness and guilt
35
what is Obsessive Compulsive disorder (OCD)?
- anxiety disorders
- two main components are obsessions and compulsions
36
what are the emotional characteristics of OCD?
- distress
- awareness that behaviour is excessive
37
what are the behavioural characteristics of OCD?
- repetitive compulsive behaviours aimed at reducing the anxiety
- behaviour may not be connected with what they are aimed at ie. compulsively avoiding a certain object to avoid something bad happening
38
what are the cognitive characteristics of OCD?
- recurring intrusive thoughts that are perceived as inappropriate
- uncontrollable thoughts
- recognition that obsessions are irrational
39
what approach explains phobias?
- behavioural
- all behaviour is learned including phobias
40
what model explains how phobias are acquired and maintained?
- Two-process model
- by Mowrer
41
what does the two-process model involve?
- classical (acquisition) and operant (maintain) conditioning
42
what is the first stage of the two process model in explaining phobias?
1. acquisition of the phobia through classical conditioning
- involves learning through association
- a neutral stimulus (NS) becomes paired with an unconditioned stimulus (UCS)
- during this acquisition stage, the NS becomes associated with the UCS and eventually causes the same response as the unconditioned response (UCR)
- pairing the UCS with the NS makes the NS become a CS, leading to a conditioned response (CR)
43
what study demonstrates the acquisition stage of the two process model in explaining phobias?
Little Albert Study
- Watson and Rayner (1920)
44
what is the Little Albert study?
- demonstrates that emotional responses could be learned through classical conditioning
- Little Albert (11 months old) initially showed no signs of fear towards white furry objects ie. white rats (NS)
- conditioned response of fear was created using a long steel bar
- when Albert reached out for the rat they struck the bar with a hammer behind his head to startle him (3 times and a week later)
- afterwards, they showed Albert the rat and he began to cry
- they had conditioned a fear response to white furry objects in little Albert
45
what is the second stage of the two process model in explaining phobias?
2. maintenance of a phobia through operant conditioning
- likelihood of a behaviour being repeated is increased if the outcome is rewarding
- ie. avoidance of the phobia reduces fear and is thus reinforcing
- negative reinforcement (escaping from an unpleasant situation)
46
what is an example of maintaining a fear through operant conditioning?
- spider phobia is maintained by avoiding it
47
what are strengths to the behavioural approach explaining phobias?
support by research by people with phobias
- people with phobias often recall an incident when the phobia appeared, such as being bitten by a dog or having a panic attack in a social situation (Sul et al)
- suggests many different phobias may be the result of different processes
- ie. agoraphobes were most likely to explain their disorder in terms of a specific incident, whereas arachnophobes were most likely to cite modelling as the cause
support for social learning by Bandura and Rosenthal (1966)
- model acted as if he was in pain every time a buzzer sounded
- later on, participants who observed this showed an emotional reaction to the buzzer demonstrating an acquired 'fear' response
48
what is a limitation to the behavioural approach explaining phobias?
biological preparedness
- Seligman (1970) argued that animals are genetically programmed to rapidly learn an association between potentially life-threatening stimuli and fear
- this is representing what we would fear in our evolutionary past and why we don't acquire fears for items, ie. toasters, normally
- suggests behavioural approach cannot explain all phobias
49
what is counterconditioning and who proposed it?
- Joseph Wolpe (1958)
- as phobias are maintained by avoidance, gradual exposure to the feared stimuli should break the association of the stimuli with the fear
- involves reciprocal inhibition (learning a relaxed response instead of an anxiety response)
50
what are the two exposure therapies for treating phobias by the behavioural approach?
- systematic desensitisation
- flooding
51
what is the aim of systematic desensitisation?
- counterconditioning
- a patient is taught a relaxation response to the feared stimuli (reciprocal inhibition)
52
how does systematic desensitisation work?
- therapist helps patient work through desensitisation hierarchy
- starting at step 1 (least feared), relaxation techniques and practiced then gradually work through next steps
53
what are the 5 steps of systematic desensitisation?
1- patient learns relaxation techniques
2- construct a hierarchy of fear
3- begin at lowest level and practice relaxation techniques until fully engaged with lowest level of fear (in vitro/ in vivo)
4- patient moves up hierarchy
5- once at highest level and are able to relax with the most feared situation, they have achieved counterconditioning
54
what does in vivo mean?
real life situation
55
what does in vitro mean?
imagined scenario
56
what is the aim of flooding?
- counterconditioning
57
how does flooding work?
- skips first stages of SD
- start straight away at the most feared situation
- in vivo or in vitro
- wait it out until the anxiety reaches maximum level and adrenaline naturally decreases
- relaxation associated to previously feared stimuli
58
what is a strength of systematic desensitisation?
effectiveness
- McGrath et al reported that about 75% of patients with phobias respond to SD
- key success relies within actual contact with the feared stimulus (in vivo are more successful than in vitro) (Choy et al)
- often a number of different exposure techniques are involved (in vivo, in vitro and modelling) (Comer, 2002)
59
what is a limitation of systematic desensitisation?
not appropriate for all phobias
- öhman et all suggests the SD may not be as effective in treating phobias that have an underlying evolutionary survival component (eg. fear of the dark), than in treating phobias that have been acquired as a result of personal experience
60
what is a strength of flooding?
effectiveness
- Choy et al reported both SD and flooding were effective, however flooding was more
- Craske et al concluded that SD and flooding were equally effective
61
what is a limitation of flooding?
individual differences
- can be a highly traumatic procedure
- patients, despite being made aware of this beforehand, may quit during treatment
- reduces the ultimate effectiveness for some people
- can also lead to enhancement of a phobia in some cases
62
what approach explains depression?
- cognitive approach
- dysfunctional thought processes explain behaviour
63
what are the key studies that explain depression?
- Ellis' ABC model
- Beck's negative triad
64
what is the fundamental belief of the cognitive approach and its link to depression?
- thinking shapes our behaviour
- depression is associated with negative thoughts and Ellis' 'musturbatory' thinking
65
how is depression linked to cognition?
- result of irrational though processes
- individual focuses on negatives rather than positives
- perceptions and interpretations are distorted
- individual is seen as being the cause of their own behaviour as they control their thoughts
66
what is Ellis' ABC model (1962)?
A = activating event ie. failing exams
B = belief about that event ie. feel stupid
C = consequence of belief ie. feel they won't ever pass so become depressed
67
what did Ellis propose are the 3 most important irrational beliefs of a depressed individual?
1. I MUST be approved of
2. I MUST do well in all that I do or I am worthless
3. I MUST be happy in the world
- these are musturbatory thoughts
68
what is Beck's negative triad?
- depressed people have negative thoughts about themselves, the world and their future
69
how do the 3 components give a distorted thinking bias in Beck's negative triad?
- individuals blame themselves for any misfortune and misinterpret facts
- interact with negative schemas and cause depressive thinking
- ignore positives
70
what are cognitive biases ie. negative schemas?
- acquired during childhood
- adopt a negative view of the world
- may have been caused by criticisms from peers/ parents
- negative schemas are activated when encountering a new situation that resembles an original situation in which the schemas were learnt
71
what do negative schemas lead to?
- systematic cognitive biases in thinking
72
what are strengths of explaining depression through the cognitive approach?
support for irrational thinking linked to depression
- Hammen and Krantz found depressed people made more errors in logic when asked to interpret written material than non-depressed people
- Bates et al found depressed people who were given negative automatic thought statements become more depressed
- supports that negative thoughts may develop due to depression
practical application in therapy
- applied by CBT as best treatment for depression when used with drug treatments (Cuijpers et al)
73
what are limitations of explaining depression through the cognitive approach?
blames client rather than situational factors
- though it gives the client the power to change the way things are, it may lead to the therapist/ client overlooking situational factors (ie. family problems)
- can be a strength as it lies in focus of clients mind and recovery, but they would also need to consider environmental impacts
irrational beliefs may be realistic
- Alloy and Abramson suggested depressive realists tend to see things for what they are
- they gave more accurate estimates of likelihood of a disaster than 'normal' controls ('sadder but wiser' effects)
74
how does the cognitive approach go about treating depression?
- Cognitive behavioural therapy (CBT)
- Rational emotive behavioural therapy (REBT) by disputing irrational beliefs (Ellis' extension of DEF to the ABC model)
75
what are the types of disputing when treating depression with the cognitive approach (REBT)?
- logical disputing
- empirical disputing
- pragmatic disputing
76
what is logical disputing?
- when self defeating beliefs do not follow logically from the information available
77
what is empirical disputing?
- when self defeating beliefs may be consistent with reality
78
what is pragmatic disputing?
- emphasises the lack of usefulness of self defeating beliefs
79
how does Ellis' DEF extension suggest depression is treated (REBT)?
D = disputing thoughts
E = effects of disputing
F = feelings produced as a result
80
what is the aim of disputing irrational beliefs?
- individuals should have their thoughts changed to those that are more rational
- individual should have the ability to stop catastrophising
- individual should feel better and be more self-accepting
81
how does CBT treat depression?
- identify negative thought patterns, challenge them, and replace them with more positive and realistic ones
82
what alternative factors does CBT also involve?
- homework
- behavioural activation
- unconditional positive regard
83
what is homework in regards to CBT?
- clients asked to complete assignments between sessions
- tests irrational beliefs against reality and putting new rational beliefs into practice
84
what is behavioural activation in regards to CBT?
- encourages clients to become more active and engage in pleasurable activities
85
what is unconditional positive regard in terms of CBT?
- convincing the client of their value as a human being (Ellis, 1994)
86
what are strengths for the cognitive approach in treating depression?
research support
- Ellis claimed 90% success rate for REBT, taking 27 sessions to complete the treatment
- Cuijers did a review of 75 studies and found that CBT was better than no treatment
- therapist competence also appears to explain a significant amount of the variation in CBT outcomes
support for behavioural activation
- Babyale et al studied 156 adult volunteers diagnosed with major depression, and randomly assigned them to a 4 month course of aerobic exercise, drug treatment or a combination of both
- clients in all 3 groups showed a significant improvement at the end
- 6 months later, those in the exercise group had significantly lower relapse rates than those in the medication group
- suggests changes in behaviour can be beneficial in treating depression
87
what are limitations of the cognitive approach in treating depression?
individual differences
- appears to be less suitable for those with high levels of irrational beliefs that are both rigid and resistant to change (Elluri et al)
- less suitable for individuals whose stress levels reflect realistic stressors in the persons life that therapy cannot resolve (Simons et al)
- individual differences affect effectiveness
88
which approach explains OCD?
- biological approach
- includes genetic explanations and neural explanations
89
what are the genes concerned with genetic explanations for OCD?
- COMT gene
- SERT gene
90
what is the COMT gene and how does it link to OCD?
- one form of COMT gene has been found common in OCD sufferers
- regulates production of dopamine which has been been implicated in OCD
- this variation leads to lower activity of COMT gene and higher levels of dopamine (Tuke et al)
91
what is the SERT gene and how does it link to OCD?
- involved in transport of serotonin, mutation of this gene leads to lower levels of serotonin
- mutation of this gene was found in two unrelated families, 6/7 had OCD (Ozaki et al)
92
how does the SERT and COMT gene link to diathesis stress?
- these genes create a vulnerability to mental disorders but other factors (stressors) influence the development of disorders
- some people may have the variation but may never develop a disorder if its not triggered by an environmental stressor
93
what are the factors concerned with neural explanations for explaining OCD?
- high dopamine levels
- low serotonin levels
- abnormal brain circuits
94
what does high dopamine levels mean in relation to OCD?
- in animal studies, stereotyped movements similar to compulsions in OCD found
- found they had high dopamine levels
95
what does low serotonin levels mean in relation to OCD?
- antidepressants that increase serotonin levels help with OCD compared to antidepressants that have little effect on serotonin
96
what does having abnormal brain circuits mean in relation to OCD?
- caudate nucleus supresses signal from orbifrontal cortex (OFC) which signals the thalamus about worry
- damage to the caudate nucleus means OFC is not supressed
- evidence from PET scans whilst symptoms are active
- abnormal levels of serotonin (linked to OFC) and dopamine (located in basal ganglia) are thought to cause this malfunction
97
what are strengths of the biological approach to explaining OCD?
abnormal neurotransmitter levels have been found
- Menzies used fMRI scans to observe grey matter in the brain and found this was reduced in OCD sufferers
- anatomical differences can be inherited and give a risk factor
family studies offer evidence for a genetic basis of OCD
- Nestadt found those with a first degree relative with OCD were 5x more likely to develop it
- Billett's meta analysis found monozygotic twins were 2x as likely to develop it if their twin had the disorder
98
what are limitations of the biological approach to explaining OCD?
studies of people with other disorders (ie. Tourette's Syndrome where its been found that OCD is one expression of the same gene in Tourettes)
- also been found in children with autism, anorexia sufferers and those with depression
- suggests OCD does not have specific unique genes give a vulnerability towards obsessive behaviours and can be triggered by the environment (diathesis-stress)
99
what way can OCD be treated with the biological approach?
- through drug therapy
100
what does drug therapy include?
- antidepressants
- antianxiety drugs
- other drugs
101
what are types of antidepressants used to treat OCD?
- SSRI's
- Tricyclics
102
what are types of antianxiety drugs used to treat OCD?
- Benzodiazepines
103
what other drugs can be used to treat OCD?
- D-cycloserine
104
how do SSRI's treat OCD?
- increase serotonin levels in the brain
- inhibits reabsorption
105
how do tricyclics treat OCD?
- blocks transporter mechanism that reabsorbs serotonin and noradrenaline
- prolongs their activity as the neurotransmitters are left in the synapse
- more side effects so only used when SSRI's are ineffective
106
how do Benzodiazepines (eg. valium) treat OCD?
- slows down activity of central nervous system by enhancing GABA (neurotransmitter with calming effect on brain neurones)
- increases flow of chloride ions into the neuron, making it harder for the neuron to be stimulated
- individual is them more relaxed
107
how does D-Cycloserine treat OCD?
- found to reduce anxiety
- antibiotic for tuberculosis
- also enhances action of GABA
- especially effective when combined with psychotherapy
108
what are strengths of the biological approach for treating OCD?
effectiveness
- Soomro et al reviewed 17 studies of the use of SSRI's with OCD patients and found them to be more effective than placebos in reducing symptoms of OCD up to 3 months after treatment
- however, most studies are only 3 to 4 months duration (Koran et al)
preferred to other treatments
- require little input from patients
- unlike psychotherapies (ie. CBT) as patients need to attend regular meetings
- cheaper for the health service as they require little monitoring and cost less than psychological therapies
- more economical
109
what are limitations of the biological approach to treating OCD?
side effects
- ie. nausea, headaches, insomnia for SSRI's (Soomro et al)
- tricyclics have more severe side effects (ie. hallucinations) so are only used when SSRI's aren't effective
- benzodiazepines cause increased aggression and long term impairment of memory, as well as addiction problems so use should be limited to maximum of 4 weeks (Ashton, 1997)
not a lasting cure
- Maina et al found patients relapse within a few weeks if medication stops
- Koran et al found that despite drug therapies being commonly used, psychotherapies (ie. CBT) should be tried first
- drugs only have short term effects
