PSYCHOPATHOLOGY

Question 1

STATISTICAL INFREQUENCY
According to the statistical definition any relatively common (usual) behaviour or characteristic can be thought of as ‘normal’, and any behaviour that lies on both ends of a normal distibution curve (unusual) is abnormal:

EXAMPLE: IQ AND INTELLECTUAL DISABILITY DISORDER

Answer 1

This statistical approach comes into its own when dealing with characteristics that can be reliably measured, for example intelligence. In any human characteristic, the majority of people’s scores will cluster around the average, and that the further we go above or below that average, the fewer people will attain that score. This is called the normal distribution.
The average IQ is set at 100. In a normal distribution, most people (68%) have a score (IQ) in the range from 85 to 115. Only 2% of people have a score below 70. Those individuals scoring below 70 are very unusual or abnormal and are liable to receive a diagnosis of a psychological disorder - intellectual disability disorder (IDD).

Question 2

AO3: strength of STATISTICAL INFREQUENCY

useful for diagnosing IDD and depression

Answer 2

One strength of statistical infrequency is its usefulness.
Statistical infrequency is used in clinical practice, both as part of formal diagnosis and as a way to assess the severity of an individual’s symptoms. For example, a diagnosis of intellectual disability disorder requires an IQ of below 70 (bottom 2%). An example of statistical infrequency used in an assessment fool is the Beck depression inventory (BDI). A score of 30+ (top 5% of respondents) is widely interpreted as indicating severe depression.
This shows that the value of the statistical infrequency criterion is useful in diagnostic and assessment processes.

Question 3

AO3: limitation of STATISTICAL INFREQUENCY

infrequent characteristics can be positive - IQ

Answer 3

One limitation of statistical infrequency is that infrequent characteristics can be positive as well as negative.
For ever person with an IQ below 70, there is another with an IQ above 130. Yet, we would not think of someone as abnormal for having a high IQ. Similarly, we would not think of someone with a very low depression score on the BDI as abnormal. These examples show that being unusual or at one end of a psychological spectrum does not necessarily make someone abnormal.
This means that, although statistical infrequency can form part of assessment and diagnostic procedures, it is never sufficient as the sole basis for defining abnormality.

Question 4

DEVIATION FROM SOCIAL NORMS
Most of us notice people whose behaviour represents a deviation from social norms, i.e. when a person behaves in a way that is different from how we expect people to behave. Groups of people choose to define behaviour as abnormal on the basis that it offends their sense of what is acceptable or the norm.
We are making a collective judgement as a society about what is right.
Social norms may be different for each generation and different in every culture, so

Answer 4

there are relatively few behaviours that would be considered universally abnormal on the basis that they breach social norms.
For example, homosexuality was considered abnormal in our culture in the past and continues to be viewed as abnormal (and illegal) in some cultures. Therefore, norms are specific to the culture we live in

Question 5

AO3: strength of DFSN

useful in psychiatry - APD

Answer 5

One strength of deviation from social norms is its usefulness.
Deviation from social norms is used in clinical practice. For example, the key defining characteristic of antisocial personality disorder is the failure to conform to culturally acceptable ethical behaviour - e.g. recklessness, aggression, violating the rights of others and deceitfulness. These signs of the disorder are all deviations from social norms.
Such norms also play a part in the diagnosis of schizotypal personality disorder, where the term ‘strange’ is used to characterise the thinking, behaviour, and appearance of people with the disorder.
This shows that the deviation from social norms criterion has value in psychiatry.

Question 6

AO3: limitation of DFSN

cultural and situational relativism

Answer 6

One limitation of deviation from social norms is the variability between social norms in different cultures and even different situations.
A person from one cultural group may label someone from another group as abnormal using their standards rather than the person’s standards. For example, the experience of hearing voices is the norm in some cultures as messages from ancestors) but would be seen as a sign of abnormality in most parts of the UK. Also, even within one cultural context social norms differ from one situation to another. For example, it is fine to be naked in a nudist beach, but not in the town square.
This means that it is difficult to judge deviation from social norms across different situations and cultures.

Question 7

FAILURE TO FUNCTION ADEQUATELY
A person may cross the line between ‘normal’ and ‘abnormal’ at the point when they can no longer cope with the demands of everyday life.
We might decide that someone is not functioning adequately when they are unable to maintain basic standards of nutrition and hygiene.
We might also consider that they are no longer functioning adequately if they cannot hold down a job or maintain relationships with people around them.

Seligman has proposed some additional signs that can be used to determine when someone is not coping. These include:

Answer 7

· When a person no longer conforms to standard interpersonal rules
· When a person experiences severe personal distress.
· When a person’s behaviour becomes irrational or dangerous to themselves or others.

Question 8

AO3: strength of FFA

sensible treshold for help

Answer 8

One strength of the failure to function criterion is that it represents a sensible threshold for when people need professional help.
Most of us have symptoms of mental disorder to some degree at some time. In fact, according to the mental health charity Mind, around 25% of people in the UK will experience a mental health problem in any given year. However, many people press on in the face of fairly severe symptoms. It tends to be at the point that we cease to function adequately that people seek professional help or are noticed and referred for help by others.
This criterion means that treatment and services can be targeted to those who need them most.

Question 9

AO3: limitation of FFA

discriminative - non standard lifestyles

Answer 9

One limitation of failure to function is that it is easy to label non-standard lifestyle choices as abnormal.
In practice it can be very hard to say when someone is really failing to function and when they have simply chosen to deviate from social norms. Not having a job or permanent address might seem like failing to function, and for some people it would be. However, people with alternative lifestyles choose to live off-grid: Similarly, those who favour high -risk leisure activities or unusual spiritual practices could be classed, unreasonably, as irrational, and perhaps a danger to self.
This means that people who make unusual choices are at risk of being labelled abnormal and their freedom of choice may be restricted.

Question 10

DEVIATION FROM IDEAL MENTAL HEALTH
Ignores the issue of what makes someone abnormal but instead think about what makes anyone ‘normal’:
Once we have a picture of how we should be psychologically healthy then we can begin to identify who deviates from this ideal.

Jahoda suggested that we are in good mental health if we meet the following criteria:

Answer 10

· We have no symptoms or distress.
· We are rational and can perceive ourselves accurately.
· We self-actualise (strive to reach our potential).
· We can cope with stress.
· We have a realistic view of the world.
· We have good self-esteem and lack guilt.
· We are independent of other people.
· We can successfully work, love, and enjoy our leisure.

Question 11

AO3: strength of DFIMH

highly comprehensive - can be discussed with a variety of professionals

Answer 11

One strength of the ideal mental health criterion is that it is highly comprehensive.
Jahoda’s concept of ideal mental health includes a range of criteria for distinguishing mental health from mental disorder. In fact, it covers most of the reasons why we might seek (or be referred for) help with mental health. This in turn means that an individual’s mental health can be discussed meaningfully with a range of professionals who might take different theoretical views e.g. a medically trained psychiatrist might focus on stress, whereas a humanistic counsellor might be more interested in self-actualisation.
This means that ideal mental health provides a checklist against which we can assess ourselves and others and discuss psychological issues with a range of professionals.

Question 12

AO3: limitation of DFIMH

cultural relativism

Answer 12

One limitation of the ideal mental health criterion is that it’s different elements are not equally applicable across a range of cultures.
Some of Jahoda’s criteria for ideal mental health are firmly located in the context of the US and Europe generally. In particular the concept of self-actualisation would probably be dismissed as self-indulgent in much of the world. Even within Europe there is quite a bit of variation in the value placed on personal independence, e.g. high in Germany, low in Italy.
Furthermore, what defines success in our working, social and love-lives is very different in different cultures.
This means that it is difficult to apply the concept of ideal mental health from one culture to another.

Question 13

BEHAVIOURAL CHARACTERISTICS OF PHOBIAS

Answer 13

panic
avoidance
endurance

Question 14

PANIC

Answer 14

A person with a phobia may panic in response to the presence of the phobic stimulus.
Panic may involve a range of behaviours including crying, screaming, or running away. Children may react slightly differently, for example by freezing, clinging, or having a tantrum.

Question 15

AVOIDANCE

Answer 15

Unless the person is making a conscious effort to face their fear, they tend to go to a lot of effort to prevent coming into contact with the phobic stimulus. This can make it hard to go about daily life.
For example, someone with a fear of public toilets may have to limit the time they spend outside the home in relation to how long they can last without a toilet. This in turn can interfere with work, education, and a social life.

Question 16

ENDURANCE

Answer 16

The alternative behavioural response to avoidance is endurance. This occurs when the person chooses to remain in the presence of the phobic stimulus.
For example, a person with arachnophobia might choose to remain in a room with a spider on the ceiling and keep a wary eye on it rather than leaving.

Question 17

EMOTIONAL CHARACTERISTICS OF PHOBIAS

Answer 17

anxiety
fear
unreasonable emotional response

Question 18

ANXIETY

Answer 18

Phobias are classed as anxiety disorders. By definition then they involve an emotional response of anxiety, an unpleasant state of high arousal. This prevents a person relaxing. and makes it very difficult to experience any positive emotion. Anxiety can be long term.

Question 19

FEAR

Answer 19

Fear is the immediate and extremely unpleasant response we experience when we encounter or think about a phobic stimulus. It is usually more intense but experienced for shorter periods than anxiety.

Question 20

UNREASONABLE EMOTIONAL RESPONSE

Answer 20

The anxiety or fear is much greater than is ‘normal’ and disproportionate to any threat posed. For example, a person with arachnophobia will have a strong emotional response to a tiny spider. Most people would respond in a less anxious way even to a poisonous spider.

Question 21

COGNITIVE CHARACTERISTICS OF PHOBIAS
The cognitive element is concerned with the ways in which people process information.
People with phobias process information about phobic stimuli differently from other objects or situations.

Answer 21

selective attention to the phobic stimulus
cognitive distortions
irrational beliefs

Question 22

SELECTIVE ATTENTION TO THE PHOBIC STIMULUS

Answer 22

If a person can see the phobic stimulus, it is hard to look away from it. Keeping our attention on something really dangerous is a good thing as it gives us the best chance of reacting quickly to a threat, but this is not so useful when the fear is irrational.

Question 23

IRRATIONAL BELIEFS

Answer 23

A person with a phobia may hold unfounded thoughts in relation to phobic stimuli, ie that can’t easily be explained and don’t have any basis in reality.
This kind of belief increases the pressure on the person to perform well in social situations.

Question 24

COGNITIVE DISTORTIONS

Answer 24

The perceptions of a person with a phobia may be inaccurate and unrealistic.
So, for example, someone with mysophobia sees mushrooms as disgusting, and an ophidiophobia may see snakes as alien and aggressive looking.

Question 25

ACQUISITION BY CLASSICAL CONDITIONING
Classical conditioning involves learning to associate something of which we initially have no fear (called a neutral stimulus) with something that already triggers a fear response known as an unconditioned stimulus).
Watson and Rayner created a phobia in a 9-month-old baby called ‘Little Albert’.

Answer 25

Albert showed no unusual anxiety at the start of the study when shown a white rat he tried to play with it. However, the experimenters then set out to give Albert a phobia. Whenever the rat was presented to Albert the researchers made a loud, frightening noise by banging an iron bar close to Albert’s ear. This noise is an unconditioned stimulus (UCS) which creates an unconditioned response (UCR) of fear. When the rat (a neutral stimulus, NS) and the UCS are encountered close together in time the NS becomes associated with the UCS, and both now produce the fear response - Albert displayed fear when he saw a rat (the NS). The rat is now a learned or conditioned stimulus (CS) that produces a conditioned response (CR)/
This conditioning then generalised to similar objects. They tested Albert by showing him other furry objects such as a non-white rabbit, a fur coat and Watson wearing a Santa Claus beard made out of cotton balls. Little Albert displayed distress at the sight of all of these.

Question 26

THE TWO-PROCESS MODEL
The behavioural approach emphasises the role of learning in the acquisition of behaviour.
Mower proposed the two-process model based on the behavioural approach to phobias.
This states that

Answer 26

phobias are learnt by classical conditioning and maintained because of operant conditioning

Question 27

MAINTENANCE BY OPERANT CONDITIONING
Responses acquired by classical conditioning usually tend to decline over time. However, phobias are often long-lasting. Mower has explained this as the result of operant conditioning.
Reinforcement tends to increase the frequency of a behaviour.
In the case of negative reinforcement an individual avoids a situation that is unpleasant. Such a behaviour results in a desirable consequence, which means the behaviour will be repeated.
Mower suggested that whenever we avoid a phobic stimulus,

Answer 27

we successfully escape the fear and anxiety that we would have experienced if we had remained there. This reduction in fear reinforces the avoidance behaviour and so the phobia is maintained.

Question 28

AO3: strength of BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS

real world application - SD and flooding

Answer 28

One strength of the two-process model is its real-world application in exposure therapies such as systematic desensitisation and flooding.
The distinctive element of the two-process model is the idea that phobias are maintained by avoidance of the phobic stimulus. This is important in explaining why people with phobias benefit from being exposed to the phobic stimulus. Once the avoidance behaviour is prevented it ceases to be reinforced by the experience of anxiety reduction and avoidance therefore declines.
In behavioural terms the phobia is the avoidance behaviour so when this avoidance is prevented the phobia is cured.
This shows the value of the two-process approach because it identifies a means of treating phobias.

Question 29

AO3: strength of BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS

research support - Ad de Jongh

Answer 29

A further strength of the two-process model is evidence for a link between bad experiences and phobias.
Ad De Jongh et al. found that 73% of people with a fear of dental treatment had experienced a traumatic experience, mostly involving dentistry (others had experienced being the victim of violent crime). This can be compared to a control group of people with low dental anxiety where only 21% had experienced a traumatic event.
This confirms that the association between stimulus (dentistry) and an unconditioned response (pain) does lead to the development of the phobia.

Question 30

AO3: limitation of BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS

not all phobias are acquired through conditioning

Answer 30

Not all phobias appear following a bad experience.
In fact, some common phobias such as snake phobias occur in populations where very few people have any experience of snakes let alone traumatic experiences. Furthermore, not all traumatic experiences lead to a phobia- someone may be in a car accident, but never the develop a phobia of cars.
This suggests we are more likely to have phobias of things which posed a danger for our ancestors, and they provide adaptive advantage.
This is a problem for the behaviourist approachof explaining phobias because it means that more than conditioning is involved in the development of phobias

Question 31

SYSTEMATIC DESENSITISATION
Systematic desensitisation (SD) is a behavioural therapy designed to gradually reduce phobic anxiety through the principles of classical conditioning:

Answer 31

If a person can learn to relax in the presence of the phobic stimulus they will be cured.
Essentially a new response to the phobic stimulus is learned (phobic stimulus is paired with relaxation instead of anxiety). This learning of a different response is called counterconditioning.

Question 32

There are three processes involved in SD:

Answer 32

create anxiety hierarchy
relaxation techniques
move up the hierarchy

Question 33

anxiety hierarchy

Answer 33

is put together by a client with phobia and therapist. This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening. For example, a person with arachnophobia might identify a picture of a small spider as low on their anxiety hierarchy and holding a tarantula at the top of the hierarchy.

Question 34

relaxation techniques

Answer 34

The therapist teaches the client to relax as deeply as possible. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is called reciprocal inhibition. The relaxation might involve breathing exercises or, alternatively, the client might learn mental imagery techniques. Clients can be taught to imagine themselves in relaxing situations or they might learn meditation.

Question 35

move up the hierarchy

Answer 35

Finally, the client is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, starting at the bottom of the anxiety hierarchy. When the client can stay relaxed in the presence of the lower levels of the phobic stimulus, they move up the hierarchy.
Treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy.

Question 36

FLOODING
Flooding involves exposing people with a phobia to their phobic stimulus but without a

Answer 36

gradual build-up in an anxiety hierarchy. Instead flooding involves immediate exposure to a very frightening situation.

Question 37

Flooding stops phobic responses very quickly. This may be because

Answer 37

without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless.
In classical conditioning terms this process is called extinction. A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten). The result is that the conditioned stimulus no longer produces the conditioned response (fear).

Question 38

AO3: strength of BEHAVIOURAL APPROACH TO TREATING PHOBIAS

SD research support - Gilroy

Answer 38

One strength of systematic desensitisation (SD) is the evidence base for its effectiveness.
Gilroy et al. followed up 42 people who had SD for spider phobia in three 45-minute sessions. At both three and 33 months, the SD group were less tearful than a control group treated by relaxation without exposure.
This means that SD is likely to be helpful for people with phobias.

Question 39

AO3: strength of BEHAVIOURAL APPROACH TO TREATING PHOBIAS

FLOODING - cost effective

Answer 39

One strength of flooding is that it is highly cost-effective.
Clinical effectiveness means how effective a therapy is at tackling symptoms. However, when we provide therapies in health systems like the NHS, we also need to think about how much they cost. A therapy is cost-effective if it is clinically effective and not expensive. Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result. Even allowing for a longer session makes flooding more cost-effective.
This means that more people can be treated at the same cost with flooding than with SD or other therapies.

Question 40

AO3: strength of BEHAVIOURAL APPROACH TO TREATING PHOBIAS

SD useful for people with learing disabilities

Answer 40

A further strength of SD is that it can be used to help people with learning disabilities.
Some people requiring treatment for phobias also have a learning disability. However, the main alternatives to SD are not suitable. People with learning disabilities often struggle with cognitive therapies that require complex rational thought. They may also feel confused and distressed by the traumatic experience of flooding.
This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias.

Question 41

AO3: limitation of BEHAVIOURAL APPROACH TO TREATING PHOBIAS

FLOODING - traumatic (Schumacher)

Answer 41

One limitation of flooding is that it is a highly unpleasant experience.
Confronting one’s phobic stimulus in an extreme form provokes tremendous anxiety.
Schumacher found that participants and therapists rated flooding as significantly more stressful than SD. This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided, they obtain informed consent. More seriously, the traumatic nature of flooding means that dropout rates are higher than for SD.
This suggests that, overall, therapists may avoid using this treatment.

Question 42

BEHAVIOURAL CHARACTERISTICS OF DEPRESSION
Behaviour changes when we experience an episode of depression.

Answer 42

CHANGE TO ACTIVITY LEVELS
DISRUPTION TO SLEEP AND EATING BEHAVIOUR
AGGRESSION AND SELF-HARM

Question 43

CHANGE TO ACTIVITY LEVELS

Answer 43

Typically, people with depression have reduced levels of energy, making them lethargic.
This has a knock-on effect, with people tending to withdraw from work, education, and social life. In extreme cases this can be so severe that the person cannot get out of bed.
In some cases, depression can lead to the opposite effect - known as psychomotor agitation. These individuals struggle to relax and may end up pacing up and down.

Question 44

AGGRESSION AND SELF-HARM

Answer 44

People with depression are often irritable, and in some cases, they can become verbally or physically aggressive. This can have serious knock-on effects on a number of aspects of their life. For example, someone experiencing depression might display verbal aggression by ending a relationship or quitting a job.
Depression can also lead to physical aggression directed against the self. This includes self-harm, often in the form of cutting, or suicide attempts.

Question 45

DISRUPTION TO SLEEP AND EATING BEHAVIOUR

Answer 45

Depression is associated with changes to sleeping behaviour. A person may experience reduced sleep (insomnia), particularly premature waking, or an increased need for sleep (hypersomnia). Similarly, appetite and eating may increase or decrease, leading to weight gain or loss. The key point is that such behaviours are disrupted by depression.

Question 46

EMOTIONAL CHARACTERISTICS OF DEPRESSION

Answer 46

LOWERED MOOD
ANGER
LOWERED SELF-ESTEEM

Question 47

LOWERED MOOD

Answer 47

When we use the word ‘depressed in everyday life we are usually describing having a lowered mood, in other words feeling sad.
Lowered mood is still a defining emotional element of depression, but it is more pronounced than in the daily kind of experience of feeling lethargic and sad People with depression often describe themselves as worthless and ‘empty’.

Question 48

ANGER

Answer 48

Although people with depression tend to experience more negative emotions and fewer positive ones during episodes of depression, this experience of negative emotion is not limited to sadness. People with depression also frequently experience anger, sometimes extreme anger. This can be directed at the self or others. On occasion such emotions lead to aggressive or self-harming behaviour - which is why this characteristic appears under behavioural characteristics as well.

Question 49

LOWERED SELF-ESTEEM

Answer 49

Self-esteem is the emotional experience of how much we like ourselves. People with depression tend to report reduced self-esteem, in other words they like themselves less than usual. This can be quite extreme, with some people with depression describing a sense of self-loathing, - hating themselves.

Question 50

COGNITIVE CHARACTERISTICS OF DEPRESSION
The cognitive aspect of depression is concerned with the ways in which people process information. People experiencing depression or who have experienced depression tend to process information about several aspects of the world quite differently from the ‘normal’ ways that people without depression think.

Answer 50

POOR CONCENTRATION
ATTENDING TO AND DWELLING ON THE NEGATIVE
ABSOLUTIST THINKING

Question 51

POOR CONCENTRATION

Answer 51

Depression is associated with poor levels of concentration. The person may find themselves unable to stick with a task as they usually would, or they might find it hard to make decisions that they would normally find straightforward. Poor concentration and poor decision-making are likely to interfere with the individual’s work.

Question 52

ATTENDING TO AND DWELLING ON THE NEGATIVE

Answer 52

When experiencing a depressive episode people are inclined to pay more attention to negative aspects of a situation and ignore the positives. In other words, they tend to see a glass as half-empty rather than half-full.
People with depression also have a bias towards recalling unhappy events rather than happy ones - the opposite bias that most people have when not depressed.

Question 53

ABSOLUTIST THINKING

Answer 53

Most situations are not all-good or all-bad, but when a person is depressed, they tend to think in these terms. This is sometimes called black-and-white thinking: This means that when a situation is unfortunate, they tend to see it as an absolute disaster.

Question 54

BECK’S NEGATIVE TRIAD
Beck took a cognitive approach to explaining why some people are more vulnerable to depression than others. In particular it is a person’s cognitions that create this vulnerability.
Beck suggested three parts to this cognitive vulnerability:

Answer 54

FAULTY INFORMATION PROCESSING
NEGATIVE SELF-SCHEMA
THE NEGATIVE TRIAD

Question 55

FAULTY INFORMATION PROCESSING

Answer 55

This is when depressed people attend to the negative aspects of a situation and ignore positives. Depressed people may tend towards ‘black and white thinking’ where something is either all bad or all good.

Question 56

NEGATIVE SELF-SCHEMA

define schema first

Answer 56

A schema is a ‘package’ of ideas and information developed through experience. They act as a mental framework for the interpretation of sensory information.
A self-schema is the package of information people have about themselves.
People use schema to interpret the world, so if a person has a negative self-schema, they interpret all information about themselves in a negative way.

Question 57

THE NEGATIVE TRIAD

Answer 57

Beck suggested that a person develops a dysfunctional view of themselves because of three types of negative thinking that occur automatically, regardless of the reality of what is happening at the time.
These three elements are called the negative triad.
When a person is depressed, negative thoughts about the world (creates the impression that there is no hope anywhere), the future (thoughts reduce any hopefulness and enhance depression) and oneself are uppermost.
These thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem.

Question 58

AO3: strength of COGNITIVE APPROACH TO EXPLAINING DEPRESSION

BECK - research support (Cohen)

Answer 58

One strength generally of Beck’s cognitive model of depression is the existence of supporting research.
Cohen et al. tracked the development of 473 adolescents and monitored their levels of ‘cognitive vulnerability’. This is a term used to describe people who are predisposed to developing depression due to negative schema and faulty info processing. They found that those who were the most ‘cognitively vulnerable’ went on to develop depression more frequently.
This supports Beck’s cognitive explanation as it shows that those who shows signs of poor cognitive functioning were more likely to develop depression.

Question 59

AO3: strength of COGNITIVE APPROACH TO EXPLAINING DEPRESSION

Beck - practical application

Answer 59

A further strength of Beck’s cognitive model of depression is its applications in screening and treatment for depression.
If it is possible to screen young people for their cognitive vulnerability, then we can identify those who are at most risk of developing depression. When individuals are identified as high risk, it is possible to provide treatment such as cognitive behavioural therapy, minimising the risk of them developing depression. This is a strength because Beck’s theory has led to CBT which treats people and reduces their depressive symptoms, allowing them a better quality of life.
This means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice.

Question 60

AO3: limitation of COGNITIVE APPROACH TO EXPLAINING DEPRESSION

BECK - some aspects cant be explained

Answer 60

There are some aspects of depression that are not mentioned in Beck’s theory.
Some people with depression feel extreme anger and others even experience delusions and hallucinations.
However, these symptoms are not easily explained by looking simply at the cognitive aspects of faulty information processing.
Therefore, Beck’s theory can only be assumed to be a partial explanation of depression, not a full one.

Question 61

ELLIS’S ABC MODEL
Ellis proposed that good mental health is the result of rational thinking, defined as thinking in ways that allow people to be happy and free from pain.
To Ellis, conditions like anxiety and depression result from

Answer 61

irrational thoughts.
Ellis defined irrational thoughts, not as illogical or unrealistic thoughts, but as any thoughts that interfere with us being happy and free from pain.

Question 62

Ellis used the ABC model to explain how irrational thoughts affect our behaviour and emotional state:

A stands for

Answer 62

A) ACTIVATING EVENT
Ellis focused on situations in which irrational thoughts are triggered by external events.
According to Ellis we get depressed when we experience negative events and these trigger irrational beliefs.

Question 63

ABC MODEL
B STANDS FOR

Answer 63

B) BELIEFS
Ellis identified a range of irrational beliefs. He called the belief that we must always succeed or achieve perfection. ‘I-can’t-stand-it-itis’ is the belief that it is a major disaster whenever something does not go smoothly. Utopianism is the belief that life is always meant to be fair.

Question 64

ABC MODEL
C STANDS FOR

Answer 64

C) CONSEQUENCES
When an activating event triggers irrational beliefs there are emotional and behavioural consequences.

Question 65

AO3: strength of COGNITIVE APPROACH TO EXPLAINING DEPRESSION

ELLIS - real world application (REBT)

Answer 65

One strength of Ellis’s ABC model is its real-world application in the psychological treatment of depression.
Ellis’s approach to cognitive therapy is called rational emotive behaviour therapy or REBT for short. The idea of REBT is that by vigorously arguing with a depressed person the therapist can alter the irrational beliefs that are making them unhappy. There is some evidence to support the idea that REBT can both change negative beliefs and relieve the symptoms of depression (David et al. 2018).
This means that REBT has real-world value.

Question 66

AO3: limitation of COGNITIVE APPROACH TO EXPLAINING DEPRESSION

ELLIS - only explains reactive depression

Answer 66

One limitation of Ellis’s ABC model of depression is that it only explains reactive depression and not endogenous depression.
There seems to be no doubt that depression is often triggered by life events - what Ellis would call ‘activating events’ Such cases are sometimes called reactive depression. How we respond to negative life events also seems to be at least partly the result of our beliefs. However, many cases of depression are not traceable to life events, and it is not obvious what leads the person to become depressed at a particular time. This type of depression is sometimes called endogenous depression. Ellis’s ABC model is less useful for explaining endogenous depression.
This means that Ellis’s model can only explain some cases of depression and is therefore only a partial explanation.

Question 67

COGNITIVE BEHAVIOUR THERAPY
Cognitive behaviour therapy (CBT) is the most commonly used psychological treatment for depression and a range of other mental health issues.
CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the client’s problems. They jointly identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.
CBT then involves working to

Answer 67

change negative and irrational thoughts and finally put more effective behaviours into place.

Question 68

BECK’S COGNITIVE THERAPY
Cognitive therapy is the application of Beck’s cognitive theory of depression The idea behind cognitive therapy is to identify automatic negative thoughts about the world, the self, and the future (the negative triad). Once identified these thoughts must be challenged. This is the central component of the therapy.
As well as challenging these thoughts directly, cognitive therapy aims to

Answer 68

help clients test the reality of their negative beliefs. They might therefore be set homework, such as to record when they enjoyed an event or when people were nice to them.
This is sometimes referred to as the ‘client as scientist, investigating the reality of their negative beliefs in the way a scientist would.
In future sessions if clients say that no one is nice to them or there is no point in going to events, the therapist can then produce this evidence and use it to prove the clients’ statements are incorrect.

Question 69

ELLIS’S RATIONAL EMOTIVE BEHAVIOUR THERAPY
Rational emotive behaviour therapy (REBT) extends the ABC model to an ABCDE model - D stands for dispute and E for effect.
The central technique of REBT is to identify and dispute (challenge) irrational thoughts.
An REBT therapist would identify examples of utopianism and challenge this as an irrational belief. This would involve a

Answer 69

vigorous argument. The intended effect is to change the irrational belief and so break the link between negative life events and depression.
This vigorous argument is the hallmark of REBT. Ellis identified different methods of disputing.

Question 70

ELLIS - REBT

describe empirical and logical arguments

Answer 70

Empirical argument involves disputing whether there is actual evidence to support the negative belief.
Logical argument involves disputing whether the negative thought logically follows from the facts.

Question 71

BEHAVIOURAL ACTIVATION
As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms.
The goal of behavioural activation is

Answer 71

to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood.
The therapist aims to reinforce such activity.

Question 72

AO3: strength of COGNITIVE APPROACH TO TREATING DEPRESSION

research support - March et al

Answer 72

One strength of CBT is the large body of evidence supporting its effectiveness for treating depression.
March et al. compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents. After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved. So, CBT was just as effective when used on its own and more so when used alongside antidepressants. CBT is usually a fairly brief therapy requiring 6 to 12 sessions, so it is also cost-effective.
This means that CBT is widely seen as the first choice of treatment in public health care systems such as the NHS as it is effective in treating depression in 4 out of 5 people.

Question 73

AO3: limitation of COGNITIVE APPROACH TO TREATING DEPRESSION

lacks effectiveness for severe depression and learning disabilities

Answer 73

One limitation of CBT for depression is the lack of effectiveness for severe cases and for clients with learning disabilities.
In some cases, depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. It also seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities. In general, any form of talking therapy is not suitable for people with learning disabilities, and this includes CBI.
This suggests that CBT may only be appropriate for a specific range of people with depression.

Question 74

AO3: limitation of COGNITIVE APPROACH TO TREATING DEPRESSION

high relapse rates - Ali et al.

Answer 74

A further limitation of CBT for the treatment of depression is its high relapse rates.
Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last. Relatively few early studies of CBT for depression looked at long-term effectiveness Some more recent studies suggest that long-term outcomes are not as good as had been assumed. For example, in one study, Ali et al. assessed depression in 439 clients every month for 12 months following a course of CBT. 42% of the clients relapsed into depression within six months of ending treatment and 53% relapsed within a year.
This means that CBT may need to be repeated periodically.

Question 75

BEHAVIOURAL CHARACTERISTICS OF OCD
The behavioural component of OCD is compulsive behaviour. There are two elements to compulsive behaviours.

Answer 75

COMPULSIONS ARE REPETITIVE
COMPULSIONS REDUCE ANXIETY
AVOIDANCE

Question 76

COMPULSIONS ARE REPETITIVE

Answer 76

Typically, people with OCD feel compelled to repeat a behaviour. A common example is handwashing. Other common compulsive repetitions include counting, praying, and tidying/ordering groups of objects such as CD collections (for those who have them) or containers in a food cupboard.

Question 77

COMPULSIONS REDUCE ANXIETY

Answer 77

Around 10% of people with OCD show compulsive behaviour alone - they have no obsessions, just a general sense of irrational anxiety. However, for the vast majority, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions. For example, compulsive handwashing is carried out as a response to an obsessive fear of germs. Compulsive checking, for example that a door is locked or a gas appliance is switched off, is in response to the obsessive thought that it might have been left unsecured.

Question 78

AVOIDANCE

Answer 78

The behaviour of people with OCD may also be characterised by their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger it.
People with OCD tend to try to manage their OCD by avoiding situations that trigger anxiety. For example, people who wash compulsively may avoid coming into contact with germs. However, this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish bins, and this can in itself interfere with leading a regular life.

Question 79

EMOTIONAL CHARACTERISTICS OF OCD

Answer 79

ANXIETY AND DISTRESS
ACCOMPANYING DEPRESSION
GUILT AND DISGUST

Question 80

ANXIETY AND DISTRESS

Answer 80

OCD is regarded as a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming. The urge to repeat a behaviour (a compulsion) creates anxiety.

Question 81

ACCOMPANYING DEPRESSION

Answer 81

OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities.

Question 82

GUILT AND DISGUST

Answer 82

As well as anxiety and depression, OCD sometimes involves other negative emotions such as irrational guilt, for example over minor moral issues, or disgust, which may be directed against something external like dirt or at the self.

Question 83

COGNITIVE CHARACTERISTICS OF OCD
The cognitive approach is concerned with the ways in which people process information. People with OCD are usually plagued with obsessive thoughts, but they also adopt cognitive strategies to deal with these.

Answer 83

OBSESSIVE THOUGHTS
COGNITIVE COPING STRATEGIES
INSIGHT INTO EXCESSIVE ANXIETY

Question 84

OBSESSIVE THOUGHTS

Answer 84

For around 90% of people with OCD the major cognitive feature of their condition is obsessive thoughts, i.e. thoughts that recur over and over again. These vary considerably from person to person but are always unpleasant. Examples of recurring thoughts are worries of being contaminated by dirt and germs, or certainty that a door has been left unlocked and that intruders will enter through it, or impulses to hurt someone.

Question 85

COGNITIVE COPING STRATEGIES

Answer 85

Obsessions are the major cognitive aspect of OCD, but people also respond by adopting cognitive coping strategies to deal with the obsessions. For example, a religious person tormented by obsessive guilt may respond by praying or meditating. This may help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks.

Question 86

INSIGHT INTO EXCESSIVE ANXIETY

Answer 86

People with OCD are aware that their obsessions and compulsions are not rational.
In fact, this is necessary for a diagnosis of OCD. If someone really believed their obsessive thoughts were based on reality that would be a symptom of a quite different form of mental disorder. However, in spite of this insight, people with OCD experience catastrophic thoughts about the worst-case scenarios that might result if their anxieties were justified. They also tend to be hypervigilant.

Question 87

GENETIC EXPLANATIONS
Genes are involved in individual vulnerability to OCD.
Lewis observed that of his OCD patients,

Answer 87

37% had parents with OCD and 21% had siblings with OCD. This suggests that OCD runs in families, although what is probably passed on from one generation to the next is genetic vulnerability not the certainty of OCD.

Question 88

According to the diathesis-stress model

Answer 88

certain genes leave some people more likely to develop a mental disorder but it is not certain. Some environmental stress is necessary to trigger the condition.

Question 89

CANDIDATE GENES
Researchers have identified genes, which create vulnerability for OCD, called candidate genes. Some of these genes are involved in regulating the development of the serotonin system. For example, the gene

Answer 89

5HT1-D beta is implicated in the transport of serotonin across synapses - it increases the number of reuptake proteins in the post synaptic membrane, so serotonin is taken up faster before it can bind to the receptors.

Question 90

OCD IS POLYGENIC
However, like many conditions, OCD seems to be polygenic. This means that OCD is not caused by one single gene but by a combination of genetic variations that together significantly increase vulnerability.
Taylor

Answer 90

analysed findings of previous studies and found evidence that up to 230 different genes may be involved in OCD.
Genes that have been studied in relation to OCD include those associated with the action of dopamine as well as serotonin, both neurotransmitters believed to have a role in regulating mood.

Question 91

AO3: strength of BIOLOGICAL APPROACH TO EXPLAINING OCD

research support - Nestadt, Marini

Answer 91

There is evidence from a variety of sources which strongly suggest that some people are vulnerable to OCD as a result of their genetic makeup.
Nestadt et al. reviewed twin studies and found 68% of identical twins as opposed to 31% of non-identical twins. Furthermore, family studies by Marini has shown a person with a family member diagnosed with OCD is around 4 times as likely to develop the disorder as someone without.
These research suggest that there must be some genetic influence in the development of OCD.

Question 92

AO3: limitation of BIOLOGICAL APPROACH TO EXPLAINING OCD

environmental risk factors - Cromer

Answer 92

There are environmental risk factors that also affect the development of OCD.
There is strong evidence for the idea that genetic variation can make a person more or less vulnerable to OCD, however it does not appear to be entirely genetic in origin and environmental risk factors also trigger or increase the risk of developing OCD. Cromer et al. found 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.
This means that genetic vulnerability only provides a partial explanation for OCD.

Question 93

NEURAL EXPLANATIONS
The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain - these are neural explanations.

THE ROLE OF SEROTONIN: One explanation for OCD concerns the role of the neurotransmitter serotonin, which is believed to help regulate mood.

If a person has low levels of serotonin..

Answer 93

Neurotransmitters are responsible for relaying information from one neuron to another. If a person has low levels of serotonin, then normal transmission of mood-relevant information does not take place and a person may experience low moods.
At least some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain.

Question 94

DECISION-MAKING SYSTEMS
Some cases of OCD, and in particular hoarding disorder, seem to be associated with impaired decision-making.
This in turn may be associated with abnormal functioning of the lateral of the frontal lobes of the brain.
The frontal lobes are responsible for logical thinking and making decisions.
There is also evidence to suggest that an area called the left parahippocampal gyrus, associated with

Answer 94

processing unpleasant emotions, functions abnormally in OCD.

Question 95

AO3: strength of BIOLOGICAL APPROACH TO EXPLAINING OCD

supporting evidence for neural model

Answer 95

One strength of the neural model of OCD is the existence of some supporting evidence.
Antidepressants that work purely on serotonin are effective in reducing OCD symptomsand this suggests that serotonin may be involved in OCD. Also, OCD symptoms form part of conditions that are known to be biological in origin, such as the degenerative brain disorder Parkinson’s disease, which causes muscle tremors and paralysis (Nestadt et al. 2010). If a biological disorder produces OCD symptoms, then we may assume the biological processes underlie OCD.
This suggests that biological factors may also be responsible for OCD.

Question 96

AO3: limitation of BIOLOGICAL APPROACH TO EXPLAINING OCD

neural model - ocd-seratonin link not unique

Answer 96

One limitation of the neural model is that the serotonin-OCD link may not be unique to OCD.
Many people with OCD also experience clinical depression. Having two disorders together is called co-morbidity. This depression probably involves (though is not necessarily caused by) disruption to the action of serotonin. This leaves us with a logical problem when it comes to serotonin as a possible basis for OCD. It could simply be that serotonin activity is disrupted in many people with OCD because they are depressed as well.
This means that serotonin may not be relevant to OCD symptoms.

Question 97

DRUG THERAPY
Drug therapy for mental disorders aims to increase or decrease levels of neurotransmitters in the brain or to increase/decrease their activity.
Low levels of serotonin are associated with OCD. Therefore,

Answer 97

drugs to treat OCD work in various ways to increase the level of serotonin in the brain.

Question 98

SSRIS
The standard medical treatment used to tackle the symptoms of OCD involves a particular type of antidepressant drug called a selective serotonin reuptake inhibitor. SSRIs work on the serotonin system in the brain. Serotonin is released by the presynaptic neurons and travels across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and reused.
By preventing

what do ssris do

Answer 98

the reabsorption and breakdown, SSRIs effectively increase levels of serotonin in the synapse and thus continue to stimulate the postsynaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD.

Question 99

Dosage and other advice vary according to which SSRI is prescribed. A typical daily dose of

Answer 99

fluoxetine is 20 mg, although this may be increased if it is not benefitting the person. The drug is available as capsules or liquid.
It takes three to four months of daily use for SSRIs to have much impact on symptoms.

Question 100

COMBINING SSRIS WITH OTHER TREATMENTS
Drugs are often used alongside cognitive behaviour therapy (CBT) to treat OCD. The drugs reduce a person’s emotional symptoms, such as feeling anxious or depressed.
This means that

Answer 100

people with OCD can engage more effectively with the CBT.
In practice some people respond best to CBT alone whilst others benefit more when additionally using drugs like fluoxetine. Occasionally other drugs are prescribed alongside SSRIs.

Question 101

ALTERNATIVES TO SSRIS
Where an SSRI is not effective after three to four months the dose can be increased, or it can be combined with other drugs.
Sometimes different antidepressants are tried. People respond very differently to different drugs and alternatives work well for some people and not at all for others.
Tricyclics are

Answer 101

sometimes used, such as clomipramine.
This acts on various systems including the serotonin system where it has the same effect as SSRIs.
Clomipramine has more severe side-effects than SSRIs, so it is generally kept in reserve for people who do not respond to SSRIs.

Question 102

SNRIs (serotonin-noradrenaline reuptake inhibitors) 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 don’t respond to SSRIs.
SNRIs increase

Answer 102

levels of serotonin as well as another different neurotransmitter - noradrenaline.

Question 103

AO3: strength of BIOLOGICAL APPROACH TO TREATING OCD

research support - Soomro

Answer 103

One strength of drug treatment for OCD is good evidence for its effectiveness.
There is clear evidence to show that SSRIs reduce symptom severity and improve the quality of life for people with OCD. For example, Soomro et al. reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD. All 17 Studies showed significantly better outcomes for SSRIs than for the placebo conditions. Typically, symptoms reduce for around 70% of people taking SSRIs. For the remaining 30%, most can be helped by either alternative drugs or combinations of drugs and psychological therapies.
This means that drugs appear to be helpful for most people with OCD.

Question 104

AO3: strength of BIOLOGICAL APPROACH TO TREATING OCD

cost effective

Answer 104

One further strength of drugs is that they are cost-effective and non-disruptive to people’s lives.
A strength of drug treatments for psychological disorders in general is that they are cheap compared to psychological treatments because many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy. Using drugs to treat OCD is therefore good value for public health systems like the NHS and represents a good use of limited funds. As compared to psychological therapies, SSRIs are also non-disruptive to people’s lives. If you wish you can simply take drugs until your symptoms decline. This is quite different from psychological therapy which involves time spent attending therapy sessions.
This means that drugs are popular with many people with OCD and their doctors.

Question 105

AO3: limitation of BIOLOGICAL APPROACH TO TREATING OCD

serious side effects increase relapse rates

Answer 105

One limitation of drug treatments for OCD is that drugs can have potentially serious side-effects.
Although drugs such as SSRIs help most people, a small minority will get no benefit.
Some people also experience side-effects such as indigestion, and blurred vision. These side-effects are usually temporary; however, they can be quite distressing for people and for a minority they are long-lasting. For those taking the tricyclic clomipramine, side-effects are more common and can be more serious. For example, more than 1 in 10 people experience erection problems and weight gain, 1 in 100 become aggressive and experience heart-related problems.
This means that some people have a reduced quality of life as a result of taking drugs and may stop taking them altogether, meaning the drugs cease to be effective and increase relapse rates.