Psychopathology Flashcards
Statistical Infrequency
Implies that a disorder is abnormal if its frequency is more than 2 standard deviations away from the mean incidence rates on a bell curve.
Deviation from social norms
Abnormal behaviour is based on straying away from sociocultural norms
Deviation from ideal mental health
- proposed by Jahoda
- she focused on what would comprise the ideal mental health of an individual
- autonomy, self-actualisation, environmental mastery
Failure to function adequately
- proposed by Rosenhan and Seligman
- the individual can be considered abnormal if their mental state prevents them from carrying out a normal life
- maladaptiveness, unpredictability
AO3 Statistical infrequency
- assumes that any abnormal characteristics are automatically negative which isn’t true (eg. having an extremely high IQ score makes you a genius even if it makes you abnormal)
- too subjective (an IQ of 70 is considered normal according to SI, but one of 69 is considered to have intellectual disability disorder.
+ real life application in diagnosis (almost always used in clinical diagnoses when comparing the patient to a baseline value. Used to assess the severity of a disorder - eg. only 1% of the population suffers from scz)
AO3 Deviation from ideal mental health
- unrealistic criteria. few people ever reach self-actualisation, so by this definition we are almost all abnormal. idealistic rather than realistic –> could lead to misdiagnosis
+ allows individuals and professionals to target areas of dysfunction. if an individual has distorted thinking, it provides healthcare professionals a target to work towards to help the patient achieve an ideal mental health –> real life application in treatment of psychopathology
AO3 Deviation from social norms
- problems with cultural relativism. what is considered abnormal in one culture could be considered a good thing in another (eg. in western societies hallucinations are considered abnormal and a symptom of scz, whereas in other tribal cultures they are seen as signs from God and something praiseworthy. eg. homosexuality is acceptable in the UK but a crime in many African and Middle Eastern countries)
AO3 Failure to function adequately
- abnormality is not always accompanied by dysfunction. someone may struggle to shower everyday but still lead a happy life. Harold Shipman murdered at least 215 patients, but still didn’t display features of dysfunction –> could lead to misdiagnosis
+ the behaviour is measurable with the WHODAS checklist which means we can decide whether behaviour is abnormal in an objective way
Behavioural characteristics of phobias
Avoidance and panic
Emotional characteristics of phobias
Anxiety and not being aware that the anxiety experienced is irrational
Cognitive characteristics of phobias
Irrational beliefs & cognitive distortions
Behavioural characteristics of depression
Change in sleep/eating patterns and change in activity levels (eg. not being able to get out of bed)
Emotional characteristics of depression
Low mood, low self-esteem
Cognitive characteristics of depression
Poor concentration, absolutist thinking (I can’t visit my mum today so i’m a terrible daughter)
Behavioural characteristics of OCD
Compulsions
Emotional characteristics of OCD
Anxiety, depression, guilt and disgust
Cognitive characteristics of OCD
Obsessive thoughts, acknowledgement that their anxiety is irrational
Outline behavioural approach to explaining phobias (Mowrer and Watson & Rayner)
- Mowrer suggested that phobias are acquired via CC and maintained through OC
- W&R Little Albert case study CC
- Avoiding the phobic stimulus means avoiding the unpleasant feelings that come with it (negative reinforcement –> maintains the phobia)
AO3 for behavioural approach to explaining phobias (Mowrer and Watson & Rayner)
+ real life application in therapy. Practical use in flooding and systematic desensitisation - exposing the patient to the phobic stimulus in a controlled environment makes them realise that the stimulus is harmless and prevents operant conditioning/maintenance of the phobia
- low explanatory power. some people are scared of things they’ve never done before (eg. flying on an aeroplane or snakes). This is better explained by evolution and natural selection.
Systematic desensitisation AO1
- gradual exposure to the phobic stimulus in a controlled setting
- works to counter-condition the patient and create a new association (relaxation instead of anxiety)
- the patient and therapist create an anxiety hierarchy and work through each level with relaxation techniques
- the phobia is cured when the patient can remain relaxed at the highest anxiety level
Flooding AO1
- reduces phobic anxiety in one session
- again in a controlled environment
- if the patient was afraid of spiders, they would immediately be exposed to a room full of spiders and not be able to escape
- relies on the principle that you cannot maintain heightened anxiety for a prolonged period of time, so eventually the patient would learn that the phobic stimulus is harmless.
Systematic desensitisation AO3
+ supporting evidence: McGrath et Al found that 75% of patients with phobias were successfully treated with SD. Gilroy et Al found that patients treated with SD were less fearful after 3 and 33 months than a control group taught only relaxation techniques –> not only is SD successful, but it is a long term solution
- cannot treat all phobias: cannot treat phobias that have not developed through personal experience, like heights or the dark (evolutionary phobias)
- not cost or time effective: takes multiple sessions which can be very expensive and time consuming. if the patient decides to stop the treatment midway through the course, they will have wasted lots of money and both their and the therapist’s time.
Flooding AO3
+ cost and time effective: only takes one session which is more effective for both the patient and the therapist than SD
+ high ecological validity: unavoidable exposure to a phobia often happens IRL –> prepares the patients for when they may be unexpectedly confronted with the phobic stimulus
- ethical issues: causes extreme anxiety and potential trauma to the patient. some people may cut the treatment short to stop the anxiety levels. the relief after this could negatively reinforce the phobia rather than treat it
- real life evidence: Joseph Wolpe took a girl who was scared of cars for a 4 hour drive –> at the beginning she was hysterical but calmed down when she realised there was no danger and the phobia was cured.
Beck’s cognitive triad of depression (Cognitive Explanation)
consists of: negative view of self, the world, and the future.
depression is a result of faulty/maladaptive cognitive processes - the emotional and physical symptoms are a result of the thinking
Ellis’ ABC model (Cognitive Explanation)
Activating event (eg. losing job)
Belief (I am useless)
Consequence (Believing you’ll never get a new job –> depression)
- argues that depression is caused by irrational thoughts (and good mental health is caused by rational thinking)
AO3 - ABC model
- doesn’t account for endogenous depression (not traceable to life events) –> low explanatory power and better to take a biological approach
- blames the individual - the responsibility is given to the patient for not dealing with the Activating Event in the correct way –> this blame could worsen the individual’s depression
- not all negative thinking is irrational - Alloy and Abrahmson found that depressed people displayed the ‘sadder but wiser effect’ where they gave more accurate estimates of the likelihood of disaster than those not depressed.
+ successful application to therapy - REBT following the ABC model has been successful in treating depression and changing thought patterns. David et Al stated that REBT can change both negative beliefs and symptoms of depression
AO3 - Beck’s negative triad
+ supporting evidence: Grazioli and Terry found a positive correlation between increased vulnerability in pregnant women before and after giving birth –> supports Beck’s link between faulty cognition and depression
Cognitive Treatments of Depression - Beck
- CBT aims to change maladaptive thinking to change behaviour
- in CBT, the patient identifies their irrational thoughts (from the triad) and works with the therapist to debunk them
- patients are set h/w tasks where they record positive events that can later be used to challenge irrational thoughts.
- eg. if the negative thought is ‘i am stupid’, but they score high on an exam, the therapist would help the patient see that it is irrational to believe they are stupid
Cognitive Treatments of Depression - Ellis
- REBT (rational emotive behaviour therapy) extends Ellis’ ABC model to ABCDE (D for dispute and E for effect)
- REBT works to identify and challenge irrational thoughts
- if the patient says that everyone hates them, REBT challenges this and presents an argument to dispute this idea
- the therapist breaks the link between negative life effects and depression by changing the clients irrational belief
- the two arguments identified by Ellis are empirical (if there is evidence to support the irrational belief) and logical (disputing if the negative effect follows logically from the facts)
AO3 for Cognitive treatments of depression
- doesn’t work for all patients: relies on h/w tasks that some patients may be to depressed to engage in. furthermore, talking therapies won’t work for clients who don’t like to express themselves/lack the verbal skills to do so.
- not time/cost effective: a skilled therapist is needed for success in these treatments which can be very expensive and not accessible to everyone. furthermore, it might take a while for the depressed individual to feel confident enough to confide in the therapist which adds time onto the already lengthy treatment time (even more money)
+ research support from David et Al: investigated 170 patients with severe depression that were either treated with REBT or Fluoxetine and found that those with REBT had better outcomes after 14 weeks
+ no side effects: SSRIs can lead to sexual dysfunction, weight gain, and dependence/withdrawal issues that CBT doesn’t –> more appropriate and effect treatment
+ positive impact on the economy: the success of CBT has a positive effect on wider economy
-e.g. more people in control of their mental health so fewer sick days and improvement in productivity at work
-improves general society
Genetic explanation of OCD
OCD is inherited via the COMT and SERT genes
- COMT gene regulates dopamine. one variation of the COMT leads to higher levels of dopamine and is common in patients with OCD
- SERT gene is linked to the transport of serotonin and causes lower levels of it, which is associated with OCD (and depression)
Neural explanation of OCD - Neurotransmitters
Suggests that abnormal amounts of neurotransmitters (dopamine and serotonin) are implicated in OCD
- dopamine has been associated with compulsive behaviours in OCD
- we can deduce that serotonin plays a role in OCD as patients taking SSRIs have shown improved behaviours
Neural explanation of OCD - Brain structures
The basal ganglia and orbitofrontal cortex have been implicated in OCD
- the basal ganglia is involved in the coordination of movement, along with other processes
- patients who suffered head injuries develop OCD-like symptoms
- the orbitofrontal cortex converts sensory information into thoughts and actions
- PET scans have found higher activity in this region in patients w/ OCD
Strengths of Biological Explanation of OCD
Research support from family studies
Lewis (1936) found that 37% of patients with OCD had parents with the disorder, and 21% had siblings that suffered –> supports genetic explanation
Nestadt et Al found that 68% of identical twins and 31% of non-identical twins experience OCD –> shows strong genetic component
- however, no twin study has found an 100% concordance rate, showing environmental factors must be at play –> interactionist approach to fully understand the cause
Success of Anti-depressants
- SSRIs are effective in reducing the symptoms of OCD –> supports the role of serotonin in OCD and the neural explanation
Research support from Menzies et al: used MRI on patients with OCD and their immediate family and compared them with unrelated healthy people anf found that the patients and their close relatives had reduced grey matter in the OFC –> supports neural explanation
Weakness of Biological Explanation of OCD
Biologically reductionist:
- doesn’t consider cognitions
- some psychologists suggest that OCD is learnt through CC and maintained through OC: eg. if someone is afraid of dirt and getting sick, washing their hands reduces the anxiety and negatively reinforces the compulsions
Biological treatments of OCD
the main treatment is drug therapy that affects neurotransmitter levels
- SSRIs inhibit the absorption of serotonin which increases the levels of serotonin in the synapse
- takes 4 months on average before symptoms start to change
- anti-anxiety meds like benzodiazepines have a quietening effect on the brain by enhancing the action of GABA –> this reduces anxiety which results from obsessive thoughts
Strengths of Biological treatments of OCD
+ research support for their efficacy: Soomro et Al found that SSRIs were more effective than placebos in 17 different trials –> supports the use of biological treatments
+ cost effective: much more cost effective than CBT which makes it more accessible and is beneficial for healthcare providers
+ effective in patients that cannot engage in talking therapies/don’t engage in homework tasks/aren’t motivated enough
Weaknesses of Biological treatments of OCD
- side effects of SSRIs: indigestion, sexual dysfunction, raised blood pressure
- side effects of benzos: highly addictive and can cause long-term memory impairments and aggression –> only effective for short-term treatment
- treat the symptoms rather than the cause: SSRIs only alleviate the symptoms of OCD but don’t treat the underlying cause. furthermore, once the patient stops taking the drig they are prone to relapse –> CBT may be more effective as a long-term solution.
