Psychopathology

Question 1

DEFINITIONS OF ABNORMALITY
What are the 4 definitions of abnormality?

Answer 1

• STATISTICAL INFREQUENCY: occurs when an individual has a less common characteristic, such as being more depressed or less intelligent than most of the population.
• DEVIATION FROM SOCIAL NORMS: concerns behaviour that is different from the accepted standards of behaviour in a community or society.
• FAILURE TO FUNCTION ADEQUATELY: occurs when someone is unable to cope with the ordinary demands of day-to-day life.
• DEVIATION FROM IDEAL MENTAL HEALTH: occurs when someone doesn’t meet the criteria for ideal mental health, as outlined by Jahoda.

Question 2

DEFINITIONS OF ABNORMALITY
Evaluate Statistical Infrequency as a definition of abnormality.

Answer 2

STRENGTH: real-world application
- useful in diagnosis of depression (score of 30+ on Beck depression inventory (BDI))
- useful in diagnosis of intellectual disability disorder (IQ of lower than 70)
~~> value of statistical infrequency criteria is useful in diagnostic and assessment processes.

WEAKNESS: unusual characteristics can be positive
- IQ is normally distributed, so an IQ of <70 or >150 is “abnormal” but IQ>150 isn’t something that requires treatment
- similarly, low BDI score is technically “abnormal” (normally distributed) but is a good thing.
~~> never sufficient as the sole basis for defining abnormality

Question 3

DEFINITIONS OF ABNORMALITY
Evaluate Deviation From Social Norms as a definition of abnormality

Answer 3

STRENGTH: real-world application
- key defining characteristic of anti-social personality disorder, the signs of it are all deviations of social norms
- such norms also play a part in diagnosing schizotypal personality disorder (where behaviour is defined as “strange”, therefore socially abnormal)
~~> deviation from social norms has value in psychiatry

WEAKNESS: cultural and situational relativism
- one group’s social norms may differ or even oppose another’s social norms, e.g. hearing voices in Western culture is diagnosed as schizophrenia, whereas in other cultures it means hearing from ancestors and is associated with high authority
- cultural norms in one society differ between situations, e.g. aggressive and deceitful behaviour in a family setting is less culturally acceptable than in the context of corporate deal-making
~~> difficult to judge deviation from social norms across different situations and cultures

Question 4

DEFINITIONS OF ABNORMALITY
Evaluate Failure To Function Adequately as a definition of abnormality

Answer 4

STRENGTH: represents a threshold for help
- 25% of UK get a mental health issue each year, but many people only seek help when they begin to fail to function adequately
~~>treatment and services can be targeted to those who need them most

WEAKNESS: discrimination and social control
- some labelled as “failing to function” may be functioning fine, just in a different way to others/deviating from social norms (e.g. choosing not to have a job)
~~> people who make unusual choices may be at risk of being labelled abnormal and their freedom of choice may be restricted

Question 5

DEFINITIONS OF ABNORMALITY
Evaluate Deviation From Ideal Mental Health as a definition of abnormality

Answer 5

STRENGTH: a comprehensive definition
- criteria distinguishes mental health from mental disorder
- covers most of the reasons why we may seek professional help
- this means an individual’s mental health can be discussed meaningfully with a range of professionals who take different theoretical views (e.g. humanistic counsellor interested in self-actualisation vs medically-trained psychiatrist interested in symptoms)
~~> ‘ideal mental health’ provides a checklist against we can assess ourselves and others, and discuss psychological issues with a range of professionals

LIMITATION: cultural-specific
- Jahoda’s criteria is generally in the context of USA and Europe.
- in particular, the concept of self-actualisation would probably be dismissed as self-indulgent in much of the world.
- even within Europe there is variation in the value placed on personal independence (high value in Germany, low value in Italy)
- what defines success in our working, social and love-lives differs between cultures
~~> difficult to apply concept of ideal mental health from one culture to another

Question 6

DEFINITIONS OF ABNORMALITY
What is Jahoda’s (1958) criteria for ‘ideal mental health’? (there are 8)

Answer 6

• we have no symptoms or distress
• we are rational and can perceive ourselves accurately
• we can self-actualise
• 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 7

DEFINITIONS OF ABNORMALITY
According to Rosenhan and Seligman (1989), when is someone failing to function adequately? Give an example

Answer 7

• when a person no longer conforms to standard interpersonal rules, e.g. maintaining eye contact and personal space
• when a person experiences severe personal distress
• when a person’s behaviour becomes irrational or dangerous to themselves or others

EXAMPLE: intellectual disability disorder
- having a very low IQ, below 70
- a statistical infrequency
- an individual must also be failing to function adequately in order to be diagnosed

Question 8

DEFINITIONS OF ABNORMALITY
What is meant by statistical infrequency? Give an example

Answer 8

• any behaviour that is statistically unusual/uncommon

EXAMPLE: IQ and intellectual disability disorder
- IQ is normally distributed (most people have IQ of 100, rare to find IQ of <85 or 115<)
- those scoring below 70 are ‘abnormal’ and are diagnosed with intellectual disability disorder

Question 9

DEFINITIONS OF ABNORMALITY
What are social norms? Give an example of deviation from social norms

Answer 9

• norms are specific to the culture and generation we live in
• there are few that we would consider universally abnormal on the basis that they breach social norms, e.g. homosexuality was considered abnormal in our culture in the past and continues to be seen as abnormal in some cultures

EXAMPLE: antisocial personality disorder
- impulsive, aggressive, irresponsible
- according to DSM-5 (manual used by psychiatrists to diagnose mental disorders), one important symptom is deviation from social norms

Question 10

PHOBIAS
What is a phobia? Outline the 3 categories of phobias

Answer 10

PHOBIA:
- excessive fear and anxiety
- triggered by an object, place or situation
- the extent to the fear is disproportionate to the danger presented by the phobic stimulus

CATEGORIES:
- specific phobia: phobia of an object, such as an animal or body part, or a situation such as flying or having an injection
- social anxiety (social phobia): phobia of a certain situation such as public speaking or using a public toilet
- agoraphobia: phobia of being outside or in a public place

Question 11

PHOBIAS
Outline the 3 behavioural characteristics of phobias

Answer 11

PANIC
- panic in response to a phobic stimulus
- involves crying, screaming, running away, etc
- children may react slightly differently, e.g. clinging, freezing, tantrum

AVOIDANCE
- a person may go to a lot of effort to avoid coming into contact with the phobic stimulus
- makes it hard to go about daily life

ENDURANCE
- alternative to avoidance
- person chooses to remain in the presence of a phobic stimulus
- e.g. keeping a wary eye on the spider across the room in case it tries to come near you

Question 12

PHOBIAS
Outline the 3 emotional characteristics of phobias

Answer 12

ANXIETY
(- phobias are classed as anxiety disorders)
- emotional response of anxiety, an unpleasant state of high arousal
- prevents relaxation
- makes it difficult to experience any positive emotion
- can be long-term

FEAR
- immediate and extremely unpleasant response to an encounter with/thoughts about the phobic stimulus
- usually more intense and experienced for shorter periods than anxiety

UNREASONABLE EMOTIONAL RESPONSE
- the anxiety or fear is much greater than is ‘normal’, disproportionate to any threat posed

Question 13

PHOBIAS
Define and outline the 3 cognitive characteristics of phobias

Answer 13

cognitive characteristic: the way we think about and process information

SELECTIVE ATTENTION TO PHOBIC STIMULUS
- hard to look away from phobic stimulus if visible
- keeping attention on threat is our best chance at reacting quickly to a threat, but not so useful when fear is irrational
- e.g. a person with pognophobia may find it difficult to concentrate if there is someone with a beard in the room

IRRATIONAL BELIEFS
- person may hold unfounded (unrealistic) thoughts in reaction to phobic stimuli
- e.g. social phobias can involve beliefs like “i must always sound intelligent”
- this kind of belief increases the pressure on the person to perform well in social situations

COGNITIVE DISTORTIONS
- a person’s perceptions may be inaccurate and unrealistic

Question 14

PHOBIAS
What are these phobias?

Arachnophobia
Coulrophobia
Pognophobia
Alphabutyrophobia

Answer 14

Arachnophobia: fear of spiders

Coulrophobia: fear of clowns

Pognophobia: fear of beards

Alphabutyrophobia: fear of peanut butter

Question 15

BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS
Briefly outline the behavioural approach to explaining phobias (use the 3 key concepts and a psychologist in a sentence)

Answer 15

MOWRER’s TWO-PROCESS MODEL is based on the behavioural approach to phobias, where phobias are ACQUIRED BY CLASSICAL CONDITIONING and MAINTAINED BY OPERANT CONDITIONING

Question 16

BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS
Outline the behaviourist view on the acquisition of phobias, using an example

Answer 16

CLASSICAL CONDITIONING
- learning to associate something that we don’t initially fear (NS) with something that triggers a fear response (UCS)
- formula:
UCS –> UCR
UCS + NS –> UCR
CS –> CR

EXAMPLE: LITTLE ALBERT (Watson and Rayner 1920)
- created phobia of white rats in 9-month-old baby called ‘Little Albert’
- start: showed no signs of unusual anxiety, tried to play with a white rat when shown to him
- whenever the white rat was presented to Albert, it was presented with a loud noise which frightened him. (7 times)
- formula:
UCS (loud noise) –> UCR (fear)
UCS (loud noise) + NS (white rat) –> UCR (fear)
CS (white rat) –> CR (fear)
- Albert learned to associate the white rat with the loud noise, and so he learned to fear the white rat even without the presence of the loud noise
- this conditioning then generalised to similar objects: non-white rabbit, fur coast, Watson wearing a Santa beard made out of cotton wool balls - all of which Albert was now afraid of

Question 17

BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS
Outline the behaviourist view on the maintenance of phobias

Answer 17

OPERANT CONDITIONING
- phobia –> person avoids the phobic stimulus –> positively reinforced by the reduced feeling of fear (since they’re not in the presence of their phobia)
- Mowrer said: desirable consequences => behaviour is likely to be repeated –> will avoid the phobic stimulus more often –> phobia is maintained

Question 18

BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS
Evaluate Mowrer’s Two-Process Model

Answer 18

STRENGTH: real-world application (exposure therapies)
- 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 to being exposed to the phobic stimulus
- once avoidance behaviour is prevented, it ceases to be reinforced by the anxiety reduction => avoidance declines
- in behavioural terms, the phobia IS the avoidance behaviour so when the avoidance is prevented, the phobia is cured
~~> shows value of Two-Process Model because it identifies a means of treating phobias

STRENGTH: evidence for link between phobias and traumatic experiences
- Little Albert illustrates how a frightening experience involving a stimulus can lead to a phobia of that stimulus
- Jongh et al (2006): 73% people with a fear of dental treatment had experienced a traumatic experience (mostly involving dentistry), compared to a control group of people with low dental anxiety, where only 21% had experienced a traumatic event
~~> confirms association between stimulus (dentistry) and an UCR (pain) does lead to the development of the phobia
——-> COUNTERPOINT: not all phobias appear following a bad experience
- some common phobias (e.g. snakes) occur in populations where very few people have any experience of snakes, let alone traumatic ones
- considering other direction, not all frightening experiences lead to phobias (e.g. car crashes don’t often lead to phobia of driving etc)
~~> association between phobias and frightening experiences is not as strong as we would expect if behavioural theories provided a complete explanation

LIMITATION: neglects cognitive aspects
- Two-Process Model focuses on explaining behaviour, i.e. the key behaviour of avoiding the phobic stimulus, but phobias have a significant cognitive element too
- e.g. irrational beliefs about phobic stimulus (‘spiders are dangerous’)
- Two-Process Model explains avoidance behaviour but doesn’t offer an adequate explanation for phobic cognitions
~~> model doesn’t completely explain the symptoms of phobias

Question 19

THE BEHAVIOURAL APPROACH TO TREATING PHOBIAS
Outline Systematic Desensitisation as a treatment for phobias

Answer 19

• gradually reduces anxiety through counterconditioning

ANXIETY HIERARCHY
- put together by client and therapist
- list of phobic situation arranged from least anxiety-inducing to most
- e.g. a photo of a spider to having one crawl over you

RELAXATION
- therapist teaches patient to relax as deeply as possible
- impossible to be relaxed and afraid at the same time, one prevents the other: reciprocal inhibition
- e.g. breathing exercises, mental imagery techniques, mediation (in extreme cases we use Valium (drug))

EXPOSURE
- starting at bottom of hierarchy, client is gradually exposed to phobias stimuli while in relaxed state
- when a client can stay relaxed in one level of the hierarchy, they can move on to the next one
- treatment is successful when client can stay relaxed in high anxiety-inducing situations on their hierarchy

Question 20

THE BEHAVIOURAL APPROACH TO TREATING PHOBIAS
Outline Flooding as a treatment for phobias

Answer 20

• immediate exposure to high anxiety-inducing situation
• sessions are typically longer than SD, and often only one long session is needed
• patient is prevented from AVOIDING the phobic stimulus
• patient quickly learns that the phobic stimulus is harmless (called EXTINCTION)
• patients are exposed to the phobic stimulus until they become so EXHAUSTED from the high anxiety that they start to relax
• traumatic but NOT UNETHICAL because they give their full consent

Question 21

THE BEHAVIOURAL APPROACH TO TREATING PHOBIAS
Give two strengths of Systematic Desensitisation as a treatment for phobias

Answer 21

STRENGTH: evidence of effectiveness
- Gilroy et al (2003): followed 42 people who had SD for arachnophobia in 3 45-minute sessions
- at both 3 and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure
- Wechsler et al 2019): SD is effective for specific phobias, social phobias and agoraphobia
~~> SD likely to be effective for treating a wide range of patients with phobias

STRENGTH: Favoured with patients
- lower refusal rates (refusing to take part from the start)
- lower attrition rates (dropping out before the end)
- when given a choice, patients tend to choose SD over flooding
~~> SD appear to have higher success rate because it has lower attrition and refusal rates

Question 22

THE BEHAVIOURAL APPROACH TO TREATING PHOBIAS
Give one strength and two limitations of Flooding as a treatment of phobias

Answer 22

STRENGT: cost-effective
- at least as effective as SD for treating specific phobias
- quicker than SD
- positive implications for the economy (both for therapists - less sessions - and patients - getting back to work)
~~> patients are free of their phobia

LIMITATION: less effective with social phobias
- social phobias have cognitive aspects, situations thoughts about the social situation
- better treatment for social phobias would be cognitive therapies which tackle irrational thinking
~~> flooding not always appropriate

LIMITATION: people with learning disabilities
- people with learning difficulties often struggle with cognitive therapies that require complex rational thought
- may also feel confused and distressed by the traumatic experience of flooding
~~> Flooding is often inappropriate for people with learning disabilities who have phobias

Question 23

THE BEHAVIOURAL APPROACH TO TREATING PHOBIAS
Evaluate (one strength and two limitations) behavioural treatments of phobias
(as a whole)

Answer 23

STRENGTH: effective
P: effective
E: Gilroy et al (2003): patients who received 3 45-min SD sessions were less fearful of spiders than a control group who just received relaxation
E: counterconditioning by learning to associate relaxation with their phobic stimulus is a valid treatment for phobias
E: flooding is as effective as other treatments and is more cost-effective (fewer sessions)
L: increased credibility

WEAKNESS: suitability to all phobias
P: not every treatment is suitable for all phobias
E: SD is suitable for those with learning difficulties (struggle to understand complexities of phobias)
E: but flooding is not appropriate for those with learning difficulties or those with social anxieties, which require more cognitive-focussed treatments
E: behaviourist approach focuses on behavioural characteristics rather than cognitive, suggesting behavioural treatments such as flooding are not suitable for all patients
L: credibility reduced, might be that a combo of cognitive, behavioural and biological approaches is necessary

LIMITATION: patients’ views
P: some don’t like some of the treatments
e: SD often preferred by patients (arguably easier and more enjoyable) since relaxation training is helpful long-term and for issues other than phobias. often results in low refusal and attrition rates
E: but flooding is highly traumatic (not unethical because they’ve given their consent), and few patients are willing to continue until the end
E: would appear that success rates are lower for behavioural treatments such as flooding
should be noted that this is mostly due to patients failing to complete the treatment rather thn the treatment itself being unsuccessful
L: credibility weakened, patients should be screened and matched to the appropriate treatment before it starts

Question 24

OBSESSIVE-COMPULSIVE DISORDER (OCD)
What is OCD?

Answer 24

• anxiety disorder
• characterised by either obsessions (recurring thoughts, images etc) or compulsions (repetitive behaviours such as handwashing)
• most cases have both obsessions and compulsions

Question 25

OBSESSIVE-COMPULSIVE DISORDER (OCD)
Outline the behavioural characteristics of OCD

Answer 25

COMPULSIONS ARE REPETETIVE
- people with OCD feel compelled to repeat a behaviour
- e.g. handwashing, organising, counting, collecting/hoarding

COMPULSIONS REDUCE ANXIETY
- 10% people with OCD experience only compulsions (just a general sense of irrational anxiety
- compulsions are mostly performed in an attempt to manage the anxiety produced by the obsessions
- e.g. handwashing is a response to an obsessive fear of germs

AVOIDANCE
- attempting to reduce anxiety by avoiding situations that trigger it
- e.g. avoiding contact with germs
- can disrupt lifestyle

Question 26

OBSESSIVE-COMPULSIVE DISORDER (OCD)
Outline the 3 emotional characteristics of OCD

Answer 26

ANXIETY AND DISTRESS
- obsessive thoughts are frightening and unpleasant, the accompanying anxiety is overwhelming
- compulsions create anxiety

ACCOMPANYING DEPRESSION
- OCD often accompanied by depression
- anxiety accompanied by low mood and lack of enjoyment in activities
- compulsive behaviour tends to bring temporary relief from anxiety

GUILT AND DISGUST
- OCD sometimes involved irrational guilt (e.g. over minor moral issues) or disgust (which could be directed at something external, like dirt, or at the self)

Question 27

OBSESSIVE-COMPULSIVE DISORDER (OCD)
Outline the cognitive characteristics of OCD

Answer 27

OBSESSIVE THOUGHTS
- 90% people with OCD have obsessive thoughts (recurring)
- varies from person to person, but always unpleasant
- e.g. contaminated by germs and dirt

COGNITIVE COPING STRATEGIES
- respond by adopting cognitive coping strategies
- e.g. religious person tormented by guilt may respond by praying excessively,
- this may reduce anxiety but can make the person seem abnormal to others and distract them from everyday tasks

INSIGHT INTO EXCESSIVE ANXIETY
- people with OCD are aware that their obsessions and compulsions are irrational
- if they weren’t aware then this would be a different mental disorder
- however people with OCD think of the worst case scenario that might result if their anxieties were justified
- they tend to be hypervigilant (maintain constant alertness and keep alertness focused on potential hazards)

Question 28

BIOLOGICAL APPROACH TO EXPLAINING OCD
Outline the genetic explanation within the biological approach to explaining OCD

Answer 28

GENETIC EXPLANATION
- people inherit genes from parents which makes them more likely to develop OCD
- polygenic: Taylor (2013) predicts there are up to 230 different genes involved in OCD
- diathesis-stress model: certain genes leave us more vulnerable to get OCD; not certain, environmental factors also trigger it
- Lewis (1936): 37% OCD patients had parentS with OCD, 21% OCD patients had siblings with OCD
- COMT gene: regulates dopamine, variation of this gene causes higher dopamine levels (common in OCD)
- SERT gene: transportation of serotonin, variation of this gene causes lower serotonin levels (common in OCD)
- “aetiologically heterogenous” means OCD has different causes for different people

Question 29

BIOLOGICAL APPROACH TO EXPLAINING OCD
Outline the neural explanation within the biological approach to explaining OCD

Answer 29

• abnormal levels of neurotransmitters (e.g. serotonin - low levels associated with low moods; drugs to increase serotonin levels are effective in treating OCD symptoms) are implicated in OCD)
• abnormally high levels of dopamine are associated with compulsions of OCD
• patients who suffer damage/injury to basal ganglia often develop OCD-like symptoms (Max et al (1994): when basal ganglia is disconnected in surgery, OCD-like symptoms are reduced)
• orbitofrontal cortex converts sensory info into thoughts and actions; PET scans found higher activity in orbitofrontal cortex in those with OCD, thoughts to increase conversion of sensory info to actions (behaviours) resulting in compulsions
• left parahippocampal gyrus: associated with processing unpleasant emotions, functions abnormally in OCD

Question 30

BIOLOGICAL APPROACH TO EXPLAINING OCD
Give one strength and one weakness of the genetic explanation within the biological approach to explaining OCD

Question 31

BIOLOGICAL APPROACH TO EXPLAINING OCD
Give one strength and one weakness of the neural explanation within the biological approach to explaining OCD

Answer 31

STRENGTH: research support
- antidepressants that work purely on serotonin are effective in reducing OCD symptoms, which suggests that serotonin may be involved in OCD
- OCD form part of conditions that are known to be biological in origin, such as Parkinson’s disease (degenerative brain disorder), which causes muscle tremors and paralysis
- if a biological disorder produces OCD symptoms then we may assume that biological processes underlie OCD
~~> biological factors may be responsible for ICD

LIMITATION: the serotonin-OCD link may not be unique to OCD
- many people with OCD also experience clinical depression
- having two disorders together = co-morbidity
- this depression probably involves (though is not necessarily caused by) disruption to the action of serotonin
- could simply be that serotonin activity is disrupted in many people with OCD because they are depressed as well
~~> serotonin may not be relevant to OCD symptoms

Question 32

BIOLOGICAL APPROACH TO TREATING OCD
Outline drug therapy, specifically SSRIs as a biological approach to treating OCD

Answer 32

• drug therapy aims to increase or decrease levels of neurotransmitters in the brain or to increase/decrease their activity

SSRIs
- antidepressant called Selective Serotonin Reuptake Inhibitor (SSRI)
- serotonin is naturally found in presynaptic terminal, believed to regulate and transport mood-relevant info
- however, in patients with OCD: not enough serotonin to stimulate postsynaptic terminal
- SSRI blocks gates on ore-synaptic neuron
- => serotonin cannot be reabsorbed and recycled into the pre-synapse via reuptake
- => build-up of serotonin in synapse => overall increases serotonin levels in OCD patient’s brain to ‘typical levels’

Question 33

BIOLOGICAL APPROACH TO TREATING OCD
How can we combine drugs with other treatments to treat OCD?

Answer 33

• drugs used alongside cognitive behaviour therapy (CBT)
• drugs reduce a person’s emotional symptoms (e.g. feeling anxious/depressed)
• OCD patients can then engage more effectively with CBT
• some patients respond best to CBT alone, others benefit more when additionally using drugs like Fluoxetine
• sometimes other drugs are used alongside SSRIs

Question 34

OBSESSIVE COMPULSIVE DISORDER (OCD)
What alternatives are there to SSRIs?

Answer 34

TRICYLICS: (older type of antidepressant): e.g. CLOMIPRAMINE
- acts on various systems including serotonin systems, has same effects as an SSRI
- clomipramine has more severe side effects than SSRIs
- generally reserved for people who don’t respond to SSRIs

SEROTONIN-NORADRENALINE REUPTAKE INHIBITORS (SNRIs):
- second line of defence for those who don’t respond to SSRIs
- increases levels of serotonin and noradrenaline

Question 35

OBSESSIVE COMPULSIVE DISORDER (OCD)
Evaluate biological treatments to OCD

Answer 35

STRENGTH: clear evidence of effectiveness
- Soomro et al (2009): reviewed 17 studies that compared SSRIs to placebos in treating OCD
- all 17 studies showed significantly better outcomes for SSRIs than for the placebo conditions
- symptoms typically reduced for 70% people taking SSRIs
- remaining 30% can be helped by either alternative drug or combos of drugs and psychotherapies
~~> drugs appear to be helpful for most people with OCD
———————-> COUNTERPOINT: may not be the most effective available
- Skapinakis et al (2016): did systematic review of outcome studies, concluded that combo of cognitive and behavioural (exposure) therapies were more effective than SSRIs
~~> drugs may not be optimum treatment for OCD

STRENGTH: cost-effective and non-disruptive
- comparatively cheap treatment: 1000s of tablets can be manufactured in the time it takes to conduct 1 session of psychological therapy
- good for public health systems (e.g. NHS) and represents a good use of limited funds
- non-disruptive: simply have to remember to take the drugs until symptoms decline, compared to attending therapy sessions
~~> drugs are popular with many OCD patients and their doctors

LIMITATION: potentially serious side-effects
- possibility of indigestion, blurred vision, loss of sex drive
- usually temporary but can be distressing for people; and for a minority they can be long-lasting
-e.g. those taking the tricyclic ‘clomipramine’, 1 in 10 people experience weight gain, 1 in 100 become aggressive and experience heart-related problems
~~> some people could have a reduced quality of life as a result of taking drugs and may stop taking them altogether, making the drugs cease to be effective

Question 36

BIOLOGICAL APPROACH TO TREATING OCD
Match the researcher to the research

Soomro et al (2009)
Skapinakis et al (2016)
_____________________________

• reviewed 17 studies that compared SSRIs to placebos in treatment of OCD. all 17 studies showed significantly better outcome for SSRIs than placebo conditions
• carried out a systematic review of outcome studies and concluded that both cognitive and behavioural (exposure) therapies were more effective than SSRIs in treatment of OCD

Answer 36

Soomro et al (2009): reviewed 17 studies that compared SSRIs to placebos in treatment of OCD. all 17 studies showed significantly better outcome for SSRIs than placebo conditions

Skapinakis et al (2016): carried out a systematic review of outcome studies and concluded that both cognitive and behavioural (exposure) therapies were more effective than SSRIs in treatment of OCD

Question 37

DEPRESSION
Outline the 3 behavioural characteristics of depression

Answer 37

ACTIVITY LEVELS
- low energy => withdrawal from work/social life
- in extreme cases, can’t get out of bed
- in some cases, there is the opposite effect: psychomotor agitation (struggle to relax and may end up pacing up and down)

DISRUPTION OF SLEEP AND EATING BEHAVIOUR
- insomnia (reduced sleep) or hypersomnia (increased need for sleep)
- reduced/increased appetite => weight loss/gain

AGGRESSION AND SELF-HARM
- irritable/aggressive => leaving employment/getting fired (essentially disrupts lifestyle)
- attempted suicide/self-harm

Question 38

DEPRESSION
Outline the 3 emotional characteristics of depression

Answer 38

LOWERED MOOD
- sometimes describe themselves as worthless and empty

ANGER
- people with depression often experience more negative emotions and fewer positive emotions
- can be directed at self or others

LOW SELF-ESTEEM
- can be as extreme as self-loathing

Question 39

DEPRESSION
Outline the 3 cognitive characteristics of depression

Answer 39

POOR CONCENTRATION
- struggles with decision-making and concentrating on tasks
- => interferes with work/lifestyle

DWELLING ON NEGATIVE
- often focuses more on the negatives and ignores the positives (glass-half-empty perspective)
- bias towards recalling unhappy events (opposite to those who aren’t depressed)

ABSOLUTIST THINKING
- black-and-white thinking
- if something is unfortunate, it is an absolute disaster in the perspective of someone with depression
- situation is either all good or all bad

Question 40

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Outline and exemplify what is meant by faulty information processing, according to Beck (1967)

Answer 40

depressed people attend to the negative aspects of a situation and ignore positives. they tend to have “black and white thinking” where something is either all good or all bad (a cognitive characteristic of depression

e.g.) depressed person wins £1million on the lottery. they might focus on the fact that last week someone else won £10million rather than all the positives linked with themselves winning £1million

Question 41

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Outline what is meant by negative self-schema, according to Beck (1967)

Answer 41

• schema: package of ideas/info developed through experience. a mental framework for the interpretation of sensory information
• self-schema: package about oneself
• negative self-schema: one interprets all information about oneself in a negative way

Question 42

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Outline what is meant by Beck’s (1967) negative triad, and name the 3 elements of it

Answer 42

• a person develops a dysfunctional view of themselves because of three types of negative thinking that occur naturally, regardless of the reality of what is happening at the time
• these negative views lead a person to interpret their experiences in a negative way and so make them more vulnerable to depression
• Beck’s (1967) negative triad:
  Negative view of the world
  Negative view of the future
  Negative view of the self

Question 43

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Exemplify Beck’s (1967) negative triad

Answer 43

Negative views of the world: “everyone is against me because I’m worthless”
–> creates impression that there is no hope anywhere
Negative views of the future: “I’ll never be good at anything”
–> such thoughts reduce any hopefulness and enhance depression
Negative views of the self: I’m worthless and inadequate”
–> such thoughts enhance existing depressive feelings because they confirm existing the emotions of low self-esteem

(triangle shaped diagram where each element has arrows pointing to the neighbouring elements)

Question 44

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Name the 3 aspects of Ellis’ (1962) ABC model to explaining how irrational thoughts affect our behaviour and emotional state

Answer 44

A: activating event
B: beliefs
C: consequences

Question 45

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Outline the ‘A’ in Ellis’ (1962) ABC model

Answer 45

Activating events:
- irrational thoughts are triggered by external events
- e.g.) failing an important test

Question 46

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Outline the ‘B’ in Ellis’ (1962) ABC model

Answer 46

Beliefs:
- Ellis identified a range of irrational beliefs:
- ‘Mursturbation’ = the belief that we must always succeed or achieve perfection
- ‘I-can’t-stand-it-itis’ = the belief that it’s a major disaster whenever something doesn’t go smoothly
- ‘utopianism’ = the belief that life is always meant to be fair

Question 47

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Outline the ‘C’ in Ellis’ (1962) ABC model

Answer 47

Consequences:
- when an activating event triggers irrational beliefs, there are emotional and behavioural consequences
- e.g. if a person believes they must always succeed (mursturbation) then failing can trigger depression

Question 48

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Evaluate (2 strengths) of Beck’s (1967) negative triad as an explanation of depression

Answer 48

STRENGTH: research support
- cognitive vulnerability = ways of thinking that may predispose a person to becoming depressed (Beck’s theory of negative self-schema, faulty info processing and negative triad)
- Clark and Beck (1999) concluded that these cognitive vulnerabilities were not only more common in depressed people but also that they preceded depression
- Cohen et al (2019): confirmed Clark and Beck (1999); tracked development of 473 adolescents, regularly measuring cognitive vulnerability; found that signs of cognitive vulnerability predicted later depression
~~> shows there is an association between cognitive vulnerability and depression

STRENGTH: real-world application
- Cohen et al (2019) concluded that assessing cognitive vulnerability allows psychologists to screen young people, identifying those most at risk of developing depression in the future and monitoring them
- understanding of cognitive vulnerability can also be applied to CBT, which works to alter the kind of cognitions that make people vulnerable to depression, making them more resilient to negative life events
~~> an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice

Question 49

COGNITIVE APPROACH TO EXPLAINING DEPRESSION
Evaluate (one strength and one limitation) of Ellis’ ABC model as an explanation of depression

Answer 49

STRENGTH: real-world application
- Ellis’s approach to cognitive therapy is called rational emotive behaviour therapy (REBT)
- REBT is vigorously arguing with a depressed person, so the therapist can alter the irrational beliefs that are making them unhappy
- David et al (2018): supportive evidence that REBT can both change negative beliefs and relieve the symptoms of depression
~~> real-world value

LIMITATION: ABC model only explains reactive depression and not endogenous depression
- no doubt that ‘activating events often trigger depression (sometime called ‘reactive depression’ (reaction from activating event))
- many cases of depression are not traceable to life events and it’s not obvious what leads the person to becoming depressed, which is called endogenous depression.
- ABC model is less useful for explaining endogenous depression
~~> Ellis’s model can only explain some cases of depression and therefore is only a partial explanation

Question 50

COGNITIVE APPROACH TO TREATING DEPRESSION
Match the researcher to the research

Beck (1967)
Ellis (1962)
Clark and Beck (1999)
Cohen et al (2019)
David et al (2018)
_____________________________

• confirmed Clark and Beck (1999); tracked development of 473 adolescents, regularly measuring cognitive vulnerability; found that signs of cognitive vulnerability predicted later depression
• gave supportive evidence that REBT can both change negative beliefs and relieve the symptoms of depression
• devised the theory of cognitive vulnerability: ways of thinking that may predispose a person to becoming depressed (negative self-schema, faulty info processing and negative triad)
• concluded that these cognitive vulnerabilities were not only more common in depressed people but also that they preceded depression
• devised the ABC model of explaining depression and ABCDE model of treating it, also known as REBT

Answer 50

Beck (1967): devised the theory of cognitive vulnerability: ways of thinking that may predispose a person to becoming depressed (negative self-schema, faulty info processing and negative triad)

Ellis (1962): devised the ABC model of explaining depression and ABCDE model of treating it, also known as REBT

Clark and Beck (1999): concluded that these cognitive vulnerabilities were not only more common in depressed people but also that they preceded depression

Cohen et al (2019): confirmed Clark and Beck (1999); tracked development of 473 adolescents, regularly measuring cognitive vulnerability; found that signs of cognitive vulnerability predicted later depression

David et al (2018): - gave supportive evidence that REBT can both change negative beliefs and relieve the symptoms of depression

Question 51

COGNITIVE APPROACH TO TREATING DEPRESSION
Briefly differenciate the Cognitive and Behavioural elements to CBT

Answer 51

Cognitive:
- CBT begins with an assessment where the therapist and client work together to clarify 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

Behavioural:
- after assessment and plan, CBT then involves working to change negative and irrational thoughts and put more effective behaviours into place

Question 52

COGNITIVE APPROACH TO TREATING DEPRESSION
Outline CBT (as an application of Beck’s cognitive theory of depression)

Answer 52

Cognitive Behaviour Therapy
- challenges negative thoughts directly while also aims to help clients test the reality of their negative beliefs
- clients become scientists; set homework to record when they enjoyed an event or when people were nice to them
- then in future sessions if client says no one is nice to them or there is no point in going to social events, the therapist can produce this evidence and use it to prove the client’s statements are incorrect

Question 53

COGNITIVE APPROACH TO TREATING DEPRESSION
Outline Rational Emotive Behaviour Therapy, as an extension of Ellis’s ABC model, as a treatment of depression

Answer 53

REBT extends the ABC model to become: ABCDE
D: dispute
- e.g. client might talk about how unlucky they have been or how unfair things seem
- REBT therapist would identify these as examples of Utopianism and challenge this as an irrational belief
- this would involve a vigorous argument
- Ellis identified different methods of disputing: empirical argument (disputing the existence of evidence to support the negative belief) and logical argument (disputing whether the negative thought follows logically from the facts)
E: effect
- the intended effect is to change the irrational belief and so break the link between negative life events and depression

Question 54

COGNITIVE APPROACH TO TREATING DEPRESSION
Explain what is meant by behavioural activation

Answer 54

• as individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms
• goal of behaviour activation: to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood (exercise/going out to dinner) + therapist will reinforce such activity

Question 55

COGNITIVE APPROACH TO TREATING DEPRESSION
Evaluate CBT as a cognitive approach to treating depression

Answer 55

STRENGTH: evidence for effectiveness
- March et al (2007) compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents.
- after 36 weeks, 81% of CBT group, 81% of drug group and 86% of combination group had significantly improved
- CBT was just as effective when used on its own and more so when used alongside antidepressants
- furthermore CBT is cost-effective, usually only requiring 6-12 sessions
~~> CBT widely seen as the first choice of treatment in NHS

LIMITATION: not suitable for all clients/cases (learning disabilities or severe cases)
- some cases can be so severe that clients cannot motivate themselves to engage with cognitive work of CBT or even pay attention during sessions
- Sturmey (2005) suggests that any psychotherapy (‘talking therapy’) isn’t suitable for those with learning disabilities, which includes CBT
~~> may only be appropriate for a specific range of people with depression
——————> COUNTERPOINT: contradictory evidence
- Lewis and Lewis (2016) concluded that CBT was as effective as antidepressants and behavioural therapies for severe depression
- Taylor et al (2008) concluded that, when used appropriately, CBT can be effective for people with learning disabilities
~~> CBT may be suitable for a wider range of people than was once thought

LIMITATION: high relapse rates
- relatively few early studies of CBT looked at long-term effectiveness, but recent ones have: long-term outcomes are not as good as assumed
- Ali et al (2019) assessed depression in 439 clients every month for 12 months following CBT. 42% relapsed back into depression within 6 months of ending treatment, and 53% relapsed within a year
~~> CBT may need to be repeated periodically

Question 56

COGNITIVE APPROACH TO TREATING DEPRESSION
Match the researcher to the research

March et al (2007)
Sturmey et al (2005)
Lewis and Lewis (2016)
Taylor et al (2008)
Ali et al (2017)
________________________________

• assessed depression in 439 clients every month for 12 months following CBT. 42% relapsed back into depression within 6 months of ending treatment, and 53% relapsed within a year
• compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents. after 36 weeks, 81% of CBT group, 81% of drug group and 86% of combination group had significantly improved
• suggests that any psychotherapy (‘talking therapy’) isn’t suitable for those with learning disabilities, which includes CBT
• concluded that CBT was as effective as antidepressants and behavioural therapies for severe depression
• concluded that, when used appropriately, CBT can be effective for people with learning disabilities

Answer 56

March et al (2007): compared CBT to antidepressant drugs and also to a combination of boh treatments when treating 327 depressed adolescents. after 36 weeks, 81% of CBT group, 81% of drug group and 86% of combination group had significantly improved

Sturmey et al (2005): suggests that any psychotherapy (‘talking therapy’) isn’t suitable for those with learning disabilities, which includes CBT

Lewis and Lewis (2016): concluded that CBT was as effective as antidepressants and behavioural therapies for severe depression

Taylor et al (2008): concluded that, when used appropriately, CBT can be effective for people with learning disabilities

Ali et al (2017): assessed depression in 439 clients every month for 12 months following CBT. 42% relapsed back into depression within 6 months of ending treatment, and 53% relapsed within a year