psychopathology Flashcards
1
Q
What is statistical infrequency ?
A
Abnormality is defined as those behaviours that are extremely rare ie any behavior that is found in very few people is regarded abnormal
2
Q
What is deviation from social norms ?
A
Anyone who deviates from socially created norms ( standards of acceptable behaviour in society) is classed as abnormal
Some rules about unacceptable behaviour are implicit ie not laughing at a funeral while others are policed by law
3
Q
Not all abnormal behaviours are undesirable
A
For example very few people have an IQ over 150 but this abnormality is desirable. Therefore using SI to define abnormality means we are unable to distinguish between desirable and undesirable behaviours
4
Q
How is the definition of abnormality in terms of statistical infrequency culturally dependent ?
A
Behaviours that are statistically infrequent in one culture may be common in others ie one of the symptoms of schizophrenia is claiming to hear voices, however this is common in some cultures.
There are no universal rules of labelling a behav as abnormal
5
Q
Social norms are susceptible to change
A
For example homosexuality is acceptable in most countries in the world but in the past it was viewed as a disorder until 1973 So deviation to social norms can vary.
Lacks temporal validity
6
Q
Deviation is related to context and degree
A
judgements on deviance from social norms are often related to the context of behaviour. For example a person wearing next to nothing on a beach is regarded as normal while the same outfit in a classroom or formal gathering is regarded as abnormal.
Therefore social deviation on its own cannot offer a complete definition of abnormality
7
Q
Defining abnormality based on social norms is culturally relative
A
this is because behaviours which are social norms in one culture may not be considered normal in others. Ie hearing voices is a good example of this.
8
Q
Using statistics is an objective and unbiased way of defining abnormality
A
For example finding people in a population more than 2SDs from the mean can be done objectively and without bias
9
Q
What is failure to function adequately ?
A
A person is considered abnormal if they are unable to cope with the demands of everyday life
10
Q
What was Rosenhan and Seligman’s criteria for FFA
A
- suggested characteristics in 1989 that suggest FFA
Suffering, maladaptivenessss, unconventionality. Loss of control, irrationality, causes observer discomfort, violates moral/social standards
11
Q
What is a strength of FFA
A
Takes patient perspective into account eg criteria of suffering so can be considered quite subjective
however can be measured objectively using WHODAS which assesses someone’s ability to function
considers six key aspects: understanding and communicating, getting around, self care, getting along with people, life activities and participation is society
12
Q
Sometimes FFA is normal
A
For example after a bereavement. Ironically, ma be considered more abnormal if they functioned normally
Additionally many ppl engage in behaviour that is maladaptive/ harmful to self but they are not classed as abnormal ie adrenaline sports and smoking
13
Q
Cultural relativism of FFA
A
Different cultures may have different ideas about wat it means to function in daily life. may explain why lower class and non white patients whose life style differs from the domonant culture are often dignosed with mental disorders ( by standards of dominant culture they aare unable to function adequately
14
Q
What is the deviationtion from ideal metal health ?
A
Deviating from having a good mental health
15
Q
What characteristics did Jahoda suggest are necessary for good mental health ?
A
Positive view of self, capability of growth and development, autonomy and independence, positive friendships and relationships, able to meet demands of everyday life
16
Q
Jahoda’s criteria sets the bar too high
A
Strictly applied very few people actually meet these criteria that everyone ends up classed as abnormal and so concept becomes meaningless
Also many of the criterias are hard to measure ie how do you assess someone’ capability for personal growth ?
17
Q
Jahoda’s criteria provides useful targets
A
Targets for goal setting and treatment eg in CBT targets are set
18
Q
Deviation from ideal mental health is a positive approach
A
Focuses on the positives rather than the negatives. Jahoda’s criteria focuses on what is desirable rather than what is undesirable. Have had some influence with the positive psychology movement in the humanistic approach.
19
Q
Jahoda’s mental health criteria are culture bound
A
The goal of self actualisation is more relevant to members of individualist cultures but not collectivist cultures where the needs of the group are promoted.
20
Q
What are two methods psychologists use to diagnose mental disorders ? What is the limitation of these methods
A
DSM and ICD
Include a list of symptoms which can be used as a tool for diagnosis
Too reductionist as people can lie about their symptoms
21
Q
What are specific phobias ?
A
a fear of a specific object or situation
Ie animal type, heights, blood, enclosed spaces etc
22
Q
What are social phobias ?
A
Extreme concern about one’s own behaviour and the reactions of others
23
Q
What are the behavioral characteristics of phobias ?
A
- avoidance of any social situation as they cause anxiety ( this especially happens with a social phobia or agoraphobia)
- altering the behavior to avoid the feared object or situation
- general restlessness and easily startled
24
Q
What are cognitive characteristics of phobias ?
A
- the irrational thought processes that occur which may involve catastrophising
- selective attention to feared object ie an arachnophobic may scan top corners of a room for cobwebs
- recognition that the fear is excessive
25
What are the emotional characteristics of phobias ?
- marked and persistent fear of an object or situation
- feelings of anxiety and panic
Emotions tend to be out of proportion to the actual "threat" posed
26
Who proposed the two process model of how phobias are learnt ?
Orval Hobart Mowrer ( 1947)
27
What are the two stages of the two process model ?
classical and operant conditioning
28
describe the classical conditioning step of the two process model ?
phobia being acquired through association - association between neutral stimulus and and unconditioned stimulus causes a conditioned response to be learnt
neutral stimulus might be a furry object and the unconditioned stimulus - loud noise. The unconditioned response being fear.
Pairing these together causes the furry object ( neutral stimulus) to produce a fear response - conditioned response.
29
What is the operant conditioning step of two process model of acquiring phobias ?
- chances of a behavior being repeated increase if the outcome is rewarding
- with a phobia, the avoidance of phobic stimulus reduces fear and is therefore reinforcing. ( an example of neg reinforcement)
- individ avoids anxiety created by phobic stimulus by avoiding it completely
30
How else can phobias be acquired ?
- modelling the behaviour of others
ie seeing a parent respond to a spider with fear may lead to a similar behavioral response in a child because behaviour appears rewarding ie fearful person gets attention
31
research support for classical conditioning being involved in phobia acquisition
but not necessary for phobias
People with phobias often do remember a specific incident when their phobia appeared ie getting bitten by a dog or having a panic attack in a social situation ( Sue et al 1994
however, Sue et al suggest that different phobias may be result of different processes ie agoraphobics more likely to explain their disorder in terms of a specific incident while arachnophobics more likely to state modelling to be the cause.
32
Two process model is an incomplete explanation
a phobia isn't always created when a neutral stimulus is associated with a fearful experience
research has found that not everyone bitten by a dog develops a fear of them ( Di Nardo et al 1988)
Could be explained by diathesis stress model which proposes some ppl have a genetic vulnerability for inheriting phobias, but this disorder only manifests if triggered by live event ie dog biting you
so dog bites would only lead to phobias for people who have this vulnerability
33
Support for social learning explanation
experiment by Bandura and Rosenthal where model acted in pain every time a buzzer sounded
later, participants who had observed this showed an emotional response to buzzer, showing that modeling others can lead to phobia acquisition
34
Two process model ignores cognitive factors
- two process model ignores the cognitive approach completely which states that irrational thoughts can lead to phobias
ie a person in a lift might think that they will become trapped in a lift and suffocate ( an irrational thought)
such thoughts can lead to extreme anxiety and trigger phobia
35
What is flooding ?
A client is exposed to an extreme form of their phobia under relaxed conditions until their anxiety is extinguishecd
36
Who developed systematic desensatisation ?
Joseph Wolpe ( 1958)
37
What is the counter conditioning stage of systematic desensitisation?
patient is taught to associate the phobic stimulus with a new response ( relaxation instead of fear)
38
What is the relaxation stage of systematic desensitisation ?
therapist teaches patient relaxation techniques ie slowing down their breathing or visualising a peaceful scene
progressive muscle relexation can also be used when muscle at a time is relaxed
39
What is the desensitisation hierarchy stage of systematic desensitisation?
- introducing person to feared stimulus one stage at a time so it's not too overwhelming
- therapist and patient conduct a desensitisation hierarchy: series of imagined scenes where each one causes more anxiety than the next
40
Effectiveness of SD
research has found that SD is successful for a range of phobias
McGrath et al (1990) found that 75% of patients with phobias respond to SD
in vivo techniques more effective than imagining feared stimulus or using pictures
41
SD may not be effective for all phobias
Ohman et al 1975 have suggested that SD isn't as effective for phobias which have an underlying evolutionary component ie fear of dangerous animals, heights etc
42
effectiveness of flooding
Choy et al resported that both SD and flooding were effective, but flooding was the more effective of the two. Another review by Craske et al 2008 deduced that they were equally effective.
flooding is therefore shown to be an effective therapy for reducing phobias
43
Individual differences ( flooding)
can be a highly traumatic procedure where responses may be different based on the individual
patients may quit during treatment if they have a particularly traumatic response which reduces the ultimate effectiveness of the therapy for some
44
Strengths of behavioural therapies
- behavioural therapies to treat phobias are generally faster, cheaper and require less effort from the patient than other psychotherapies such as CBT
CBT requires a willingness for people to think deeply about their problems, "lack of thinking" aspect is good for those who lack insight into their motivations or emotions ie children or people with learning difficulties
45
Symptom substitution
- behavioural therapies may not work with certain phobias because the symptoms are just the tip of the iceberg
- even if symptoms are removed, cause will remain and so symptoms just resurface perhaps in another form ( known as symptom substitution)
- for example, according to psychodynamic approach, phobias develop due to projection. Little Hans developed a phobia of horses
- his actual problem was envy of his father but couldn't express this directly
so anxiety was projected onto horse
this case demonstrates the importance of treating underlying causes not just symptom of phobia
46
What was Ellis's ABC model ? ( 1962)
- believed that the reason for mental disorders such as depression was irrational beliefs
- A refers to activating event ie you get fired
- B is the belief which is ually irrational ie I was sacked because they hate me
- C is the consequence. national beliefs lead to healthy emotions while irrational beliefs leading to unhealthy emotions such as depression
47
What is musturbatory thinking ?
thinking that certain ideas or assumptions must be true for an individual to be happy
ie I must do very well or I am worthless
an individual who holds such beliefs bound to be disappointed or at worst depressed
these "musts" need to be challenged in order for mental health to win out
48
What is Beck's explanation for depression ?
idea that people acquire depression because their thinking is biased towards negative interpretations of the world and they lack a perceived sense of control
49
What is a negative schema ?
- tendency to adopt negative view of the world
- can be caused by factors such as parental rejection, peer rejection or criticisms from teachers
- lead to systematic cognitive biases in thinking ie overgeneralising , drawing a conclusion of self worth from one small piece of negative feedback
50
What is the negative triad ? (1967)
pessimistic view of three key elements in a person's belief system: the self ie I am just plain and undesirable, what is there to like ?
the world ( life experiences) and the future
51
blames client rather than situational factors
placing of emphasis on the client is a good thing because it gives client power to change how things are
however, the limitations of this approach are that it may cause the therapist to overlook situational factors ie how life events or family problems may have contributed to disorder
52
practical applications in therapy
The cognitive appraoch to explaining depression has been applied in CBT
CBT is found to be best treatment for depression especially when used alongside drug treatments
usefulness of CBT as a therapy supports effectiveness of cognitive approach. if depression is alleviated by challenging irrational thinking, suggests that the irrational thoughts had a role in dpression in first place
53
Irrational beliefs may be realistic
Alloy and Abramson 1979 suggest that depressive realists tend to see things fir what they are while normal people view the world through rose coloured glasses
found that depressed people gave more accurate estimates of a disaster than normal controls
54
Alternative explanations for explaining depression
- biological approach suggests that gened and neurotransmitters cause depression
- research supports the role of low levels of neurotransmitter seratonin in depressed people and has also found that the gene related to these low levels is more common in people with dpression
- existence of alternative approaches and effective therapies can't be explained by cognitive approach alone
55
How did Ellis extend his ABC model ?
- extended model to ABCDEF
- D refers to disputing irrational thoughts and beliefs, E stands for effects of disputing and effective attitude to life and F is new feelings/emotions produced
Ellis' therapy ( REBT- rational, emotional, behavioural therapy) focuses on challenging irrational thought/ belief and replacing them with more rational ones
56
Clients given homework during CBT
clients often asked to complete homework assignments during therapy sessions ie asking a person outon a date when they had been afraid to do so due to fear of rejection
vital for testing irrational beliefs against reality and putting new rational beliefs into practise
57
Behavioural activation
CBT has a specific focus on encouraging depressed clients to become more active and engage in pleasurable activities
idea that being active leads to rewards which act as a medicine to depression
58
Unconditional positive regard
Ellis ( 1994) recognised the importance of making client appreciate their value as a human , by providing respect and appreciation regardless of what client does or says ( unconditional positive regard)
this can facilitate a change in beliefs or attitudes
59
Research support for REBT and CBT
Ellis ( 1957) claimed a 90% success rate for REBT, with the treatment taking around 27 sessions to complete treatment
-A review of Cuijpers et al ( 2013) of 75 studies found that CBT was superior to no treatment
- however Ellis recognised that therapy wasn't always successful due to therapist incompetence or clients not putting revised beliefs into action
60
CBT suitable for some individuals more than others
- less suitable for people who have high levels of irrational beliefs which are rigid and opposed to change ( elkin et al 1985)
- also unsuitable for individuals where high levels of stress in person reflect realistic stressors in their life, which therapy can't fix ( Simons et al 1995)
61
Support for behavioural activation
Babyak et al 2000 studied 156 adult volunteers who were diagnosed with a major depression disorder
- randomly assigned to a 4 month course od drug treatment, aerobic exercise or both
- sixth months after study those in the exercise group had lower relapse rates than those in the drug group
- shows that physical activity can alleviate depression
62
Alternative treatments for depression
- The most popular treatment for depression is the use of drug treatments such as SSRIs
- drug therapies have the strength of needing less effort and commitment from patient
- can also be used alongside a psychotherapy such as CBT to help patient cope better
- review by Cuijpers et al found that using the two together made CBT especially effective
63
All methods of treatment for a disorder may be equally effective
- this is known as the Dodo bird effect, discovered by Rosenzweig ( 1936) named after Dodo bird in alice and wonderland who decided everyone should win
- Lubrosky et al ( 1975, 2002) reviewed over 100 studies of different therapies and found only small differences
- R argued that little difference due to may common factors in the various therapies ie being able to talk to a sympathetic person and expressing one's thoughts
64
What is the COMT gene ?
may be related to OCD, regulates production of neurotransmitter dopamine which has been found to be high in people with OCD
one allele of the COMT gene has been commonly found in OCD patients, produced lower activity of gene and thus higher dopamine lvls.
65
What is the SERT gene ?
- affects the transport of seratonin, creating lower levels of the neurotransmitter
- lower levels present in people with OCD
- one study found a mutation of this gene in two unrelated fams where 6 out of 7 members had OCD ( Ozaki et al 2003)
66
What is the diathesis-stress model/ explanation for OCD ?
- idea between one gene and a complex disorder like OCD is unlikely
- COMT and SERT gene also implicated in other disorders such as depression and PTSD
- suggests that each individual gene only creates a diathesis ( vulnerability) for OCD and other conditions
- other stressors then determine whether a mental illness will develop
67
What are dopamine levels like in people with OCD ?
- abnormally high
- evidence from animal studies, where high levels of drugs that inc dopamine have been found to trigger movements resembling the compulsive behavi of OCD
68
What are serotonin levels like in people with OCD ?
- low levels
- antidepressant drugs that increase serotonin have been found to reduce depression ( Pigott et al 1990)
69
Several areas in the frontal lobe of the brain are thought to be abnormal in people with OCD
- caudate nucleus found in the basal ganglia usually suppresses "worry" signals from the OFC ( orbital frontal cortex) to thalamus
- if damaged, caudate nucleus cannot suppress minor worry signals, thalamus is alerted and sends signals back to OFC
- creates "worry" circuit
70
How is the worry circuit supported ?
PET scans of patients with OCD displaying active symptoms ie a person with a germ obsession holding a dirty cloth shows heightened activity in OFC.
71
How are seratonin and dopamine linked to frontal lobe regions ?
- Comer ( 1998) reports that seratonin plays a key role in operation of OFC and caudate nuclei, and would therefore appear that abnormal lvls of seratonin might cause these areas to malfunction
- dopamine is the main neurotransmitter in the basal ganglia, high levels of dopamine lead to overactivity in this region
72
Evidence for genetic basis of OCD
( family studies)
Nestadt et al identified 80 patients with OCD and 343 of their first degree relatives and compared them wth 73 control patients without OCD and 300 relatives.
- found that people with a first degree relative who had OCD were 5 times more likely to develop condition than general pop
73
Evidence for genetic basis of OCD ( twin studies)
- meta- analysis of 14 twin studies found on average that identical monozygotic twins were more than twice as likely to develop OCD if their co- twin had it compared to identical dizygotic twins
- evidence of both twin and fam studies shows a clear genetic basis for OCD byt concordance rates never 100% so environment must also play a role.
74
What is concordance rate ?
measure of genetic similarity
ie in a sample of 100 twin pairs, where one twin in each pair has a phobic disorder. the number of times other twin shows illness determines the concordance rate. so if 60 other twins also have a phobic disorder, concordance rate is 60%
75
Tourette's syndrome and other disorders
Paul and Leckman ( 1986) studied patients with Tourette's syndrome and their families and found that OCD is one form of expression of the same gene that determines Tourette's. Obsessive, compulsive behaviour also found in children with autism.
This supports the view that the gene causing obsessive behaviour isn't specific to OCD but other disorders as well.
76
What research support is there for brain differences in people with OCD
- Menzies et al 2007 used MRI to produce images of brain activity in OCD patients and their family members and also a group of unrelated healthy people
- OCD patients and their family members had reduced grey matter in regions of brain including OFC
- supports view that anatomical differences are inherited and these can lead to OCD in certain individuals
77
Biological approach for explaining OCD faces competition from psychological explanations
The two process model of developing phobias can be applied to OCD.
Initial learning happens when a neutral stimulus ie dirt is associated with anxiety.
Association is maintained because anxiety provoking stimulus is avoided. So an obsession is formed therefore and a link with compulsive behaviours is learnt ie hand washing that appears to lower anxiety
This alternative explanation suggests that OCD may have psychological as well as biological causes.
78
Treating OCD - use of SSRIs
Drugs increase levels of serotonin as low serotonin levels are associated with OCD. Reduce the anxiety associated with OCD
Normally, Seratonin is released into synapse from one neuron. Targets receptor cells on receiving neuron, afterwards it is reabsorbed by initial neuron sending impulse.
To increase levels of Seratonin, this reuptake is inhibited.
79
What are some brands of SSRIs
Zoloft, Paxil, Prozac
80
Antidepressants - trycyclics
Trycyclics block the transporter mechanism that reabsorbs both Seratonin and noradrenaline into the pre synaptic cell after it has fired.
So more of the neurotransmitters are left in the synapse, prolonging their activity, and making the transmission of the next impulse easier
81
What is the advantage of tricyclics ? What is a disadvantage ?
Can target more than one neurotransmitter.
Have greater side effects so are used only where SSRIs aren't effective.
82
Anti anxiety drugs
BZs are commonly used to reduce anxiety
Slow down the activity of the central nervous system by enhancing activity of GABA neurotransmitter
- has a quietening effect on many neurons in the brain by increasing flow of chloride ions into the neuron
- make it harder for neuron to be stimulated by other neurotransmitters, so slow down activity and relax person.
83
What is D- cyloserine ?
- it can be used to treat tuberculosis but it can also reduce anxiety by enhancing the transmission of GABA - found by Kushner et al 2007 ( GABA has a quietening effect on neurons)
84
How effective are SSRIs ?
- Soomro et al 2008 reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective than placebos in reducing symptoms up to three months after treatment
- an issue is that the studies are usually only three-four months duration, so while drug treatments have been found to be effective in short term, lack of long term data is a limitation
85
Why are drug therapies often preferred over other therapies to treat disorders ?
- requires little input from user in terms of effort and time
- in contrast, therapies like CBT require patients to attend regular meetings and put considerable thought into tackling their problems
- also drug therapies are cheaper for health service as require less monitoring and cost less than psychological treatments
86
Side effects of drugs
- nausea, headache and insomnia are common side effects of SSRIs - found by Soomro et al 2008
- tricylic antidepressants tend to have more side effects than SSRIs such as hallucination and irregular heart beat
- BZ tend to have increased aggressiveness and long term impairment to memory, as well as addiction problem
- therefore the side effects and possibility of addiction limit the usefulness of drugs as OCD treatments
87
Drugs are not an effective long term cure
Maina et al 2001 found that patients went into relapse within a few weeks if medication was stopped
Koran et al 2007 stated in a comprehensive review of treatments for OCD sponsored by the American psychiatric association that psychotherapies such as CBT should be tried first, before drugs
88
Who judges failure to function adequately ?
- sometimes an individual may be quite happy with their situation and/ or not aware that they are not coping
- it is others who aren't comfortable and judge the behav as abnormal
