Psychopathology Flashcards
1
Q
Statistical infrequency
A
occurs when an individual has a less common characteristic (eg. more depressed or less intelligent)
2
Q
What is an example for statistical infrequency
A
The average IQ is set at 100. In a normal distribution most people range between 85 or 115 (68%) only 2% have below 70 and they are likely to be diagnosed with Intellectual disability disorder
3
Q
Deviation from social norms
A
Concerns behaviour that is different from the accepted standards of behaviour in society
4
Q
What is an example of deviation from social norms
A
A person with antisocial personality disorder is impulsive and aggressive. Psychopaths are seen as abnormal because they don’t conform to our moral standards.
5
Q
What is a strength of statistical infrequency (real world application)
A
-its usefulness
-used in clinical practice as part of diagnosis and a way to assess the severity of symptoms
-E.g its used in an assessment tool, Beck depression inventory
-A score of +30 is interpreted as indicating severe depression
-This sows the value of the statistical infrequency criterion is useful in diagnosis
6
Q
What is a limitation of statistical infrequency (Unusual characteristics can be positive)
A
-For everyone with an IQ below 70 there is another IQ above 130, yet someone with a high IQ isn’t abnormal.
-This example shows that being unusual or at one end of the psychological spectrum doesn’t make someone abnormal
-This means that although statistical infrequency can form part of assessment and diagnostic procedures its not sufficient as the sole basis for defining abnormality
7
Q
What is a strength of deviation from social norms (real world application)
A
-its usefulness
-used in clinical practice as part of diagnosis and a way to assess the severity of symptoms
-Key defining characteristics of antisocial personality disorder is the failure to conform to culturally acceptable ethical behaviour
-Such norms all play a part in the diagnosis of schizotypal personality disorder
-This shows that the deviation form social norms criterion has value in psychiatry
8
Q
What is a limitation of deviation from social norms (cultural and situational relativism)
A
-The variability between social norms in different cultures and even different situations
-A person from one culture might label someone as abnormal using their standards rather than the person’s standards
E.g hearing voices is the norm is some cultures but would be seen as abnormal inmost parts of the UK
-This means that it’s difficult to judge deviation from social norms across different situations and cultures
9
Q
Failure to function adequately
A
Occurs when someone is unable to cope with ordinary demands of day-to-day living
10
Q
When is someone failing to function adequately
A
Rosenhan and Seligman proposed additional signs that could be used to determine if someone is not coping:
- no longer conform to standard interpersonal rules
-experience severe personal distress
-Behaviour becomes irrational or dangerous
11
Q
What is an example of failing to function adequately
A
Before a diagnosis of intellectual disability would be made the individual must be failing to function adequately
12
Q
Deviation from ideal mental health
A
Occurs when someone does not meet a set of criteria for good mental health
13
Q
What does ideal mental health look like
A
Johada suggested that we are in good mental health when we follow the criteria:
-No symptoms or distress
-rational
-self-actualise
-cope with stress
-realistic view of the world
14
Q
What is a strength of failure to function adequately (represents a threshold for help)
A
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.
15
Q
What is a Limitation of failure to function adequately (Discrimination and social control)
A
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.
16
Q
Phobia
A
Irrational fear of an object or situation
17
Q
What are different types of phobias
A
-Specific phobia- animal, body part, object ect
-Social anxiety- social situations such as public speaking
-Agoraphobia- being outside or in public spaces
18
Q
What are behavioural characteristics of phobias
A
-Panic- crying, screaming, running away
-Avoidance- making a conscious effort to prevent coming into contact with their phobic stimulus
-Endurance- alternative to avoidance, they choose to be in the presence of the phobic stimulus
19
Q
What are emotional characteristics of phobias
A
-Anxiety- prevents them from relaxing, difficult to experience any positive emotion
-Fear- immediate and extremely unpleasant response to the phobic stimulus, usually more intense but shorter than anxiety
-Emotional response is unreasonable- anxiety/fear is much greater than is normal to the threat posed
20
Q
What are cognitive characteristics of phobias
A
-Selective attention- harder to look away from the stimulus
-Irrational beliefs- unfounded thoughts to phobic stimuli
-Cognitive distortions- perceptions of a person with a phobia may be inaccurate and unrealistic
21
Q
Depression
A
A mental disorder characterised by low moods and low energy levels
22
Q
What are the different types of depression
A
-major depressive disorder: sever but short
-persistent depressive disorder: long lasting
-disruptive mood dysregulation disorder: childhood temper tantrums
-premenstrual dysphoric disorder: disruption to mood due to menstruation
23
Q
What are behavioural characteristics of depression
A
-Activity levels- reduced, withdraw from work, education and social life, if severe cant get out of bed
-Disruption to sleep and eating behaviour- Reduced sleep or increased need for sleep, eating might increase or decrease
-Aggression and self harm- Irritable, self harm, suicide attempts
24
Q
What are emotional characteristics of depression
A
-Lowered mood- describe themselves as feeling worthless and empty
-Anger- anger, directed towards themselves or others
-Lowered self-esteem- like themselves less than usual
25
What are cognitive characteristics of depression
-poor concentration- unable to stick with a task, hard to make decisions
-Attending to and dwelling on the negative- pay more attention to the negative aspects of a situation and ignore the positives
-Absolutist thinking- black and white thinking, when a situation is unfortunate they tend to see it as a disaster
26
Obsessive compulsive disorder
A condition characterised by obsessions and/or compulsive behaviour
27
What are different types of OCD
-trichotillomania- hair pulling
-Hoarding disorder- compulsive gathering of possessions
-Excoriation disorder- skin-picking
28
What are behavioural characteristics of OCD
-Compulsions are repetitive- compelled to repeat behaviour
-Compulsions reduce anxiety- performed in an attempt to manage anxiety produced by obsessions
-Avoidance- they attempt to reduce anxiety by keeping away from situations that trigger it
29
What are emotional characteristics of OCD
-Anxiety and distress- obsessive thoughts are unpleasant and frightening and the anxiety goes with them are overwhelming
-Accompanying depression- low mood and lack of enjoyment in activities, compulsive behaviour tends to bring some relief
-Guilt and disgust- irrational guilt, might be at themselves
30
two process model of phobias
an explanation for the onset and persistence of disorders that create anxiety. The two processes are classical conditioning for onset and operant conditioning for persistence
31
Little Albert study
-Watson and Rayner (1920) created a phobia in a 9-month-old baby called 'Little Albert'.
-showed no unusual anxiety at the start of the study.
When shown a white rat he tried to play with it.
-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.
-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.
32
Classical conditioning
learning by association. Occurs when two stimuli are repeatedly paired together- UCS and a NS. The NS eventually produces the same response that was first produced by the unconditioned stimulus
33
Operant conditioning
A form of learning in which behaviour is shaped and maintained by its consequences. Possible consequences of behaviour include positive reinforcement, negative reinforcement or punishment.
34
How are phobias maintained by operant conditioning
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 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.
35
What is a strength of the two process model for phobias (real world application)
-One strength of the two-process model is its real-world application in exposure therapies (such as systematic desensitisation)
-The distinctive element of the two-process model is the idea that phobias are maintained by avoidance of the phobic stimulus.
-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.
36
What is a limitation of the two process model for phobias (Cognitive aspects of phobias)
-One limitation of the two-process model is that it does not account for the cognitive aspects of phobias.
-Behavioural explanations, including the two-process model, are geared towards explaining behaviour. In the case of phobias the key behaviour is avoidance of the phobic stimulus.
-However, we know that phobias are not simply avoidance responses - they also have a significant cognitive component.
-For example people hold irrational beliefs about the phobic stimulus (such as thinking that a spider is dangerous). The two-process model explains avoidance behaviour but does not offer an adequate explanation for phobic cognitions.
-This means that the two-process model does not completely explain the symptoms of phobias.
37
What is a strength of the two process model of phobias (phobias and traumatic experiences)
-A further strength of the two-process model is evidence for a link between bad experiences and phobias.
-The Little Albert study illustrates how a frightening experience involving a stimulus can lead to a phobia of that stimulus. More systematic evidence comes from a study by Ad De Jongh et al. (2006) who 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.
38
What is a counterpoint to support for phobias and traumatic experiences
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. Also, considering the other direction, not all frightening experiences lead to phobias.
This means that the association between phobias and frightening experiences is not as strong as we would expect if behavioural theories provided a complete explanation.
39
systematic desensitisation
A behavioural therapy designed to reduce an unwanted response, such as anxiety. SD involves drawing up a hierarchy of anxiety-provoking situations related to a person's phobic stimulus, teaching the person to relax, and then exposing them to phobic situations. The person works their way through the hierarchy whilst maintaining relaxation.
40
Flooding
A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions.
41
What are the three processes of systematic desensitisation
1. The anxiety hierarchy- 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.
2. Relaxation- The therapist teaches the client to relax as deeply as possible. It is impossible to be afraid and relaxed at the same time (reciprocal inhibition).
3. Exposure- 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.
42
How does flooding work
Flooding stops phobic responses very quickly. This may be because, 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).
43
What is a strength of systematic desensitisation (People with learning disabilities)
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.
44
What is a strength of flooding (cost effective)
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 (perhaps three hours) this 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.
45
What is a limitation of flooding (traumatic)
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 et al. (2015) 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 attrition (dropout) rates are higher than for SD. This suggests that, overall, therapists may avoid using this treatment.
46
Negative triad
Beck proposed that there are three kinds of negative thinking that contribute to becoming depressed: negative views of the world, the future and the self. Such negative views lead a person to interpret their experiences in a negative way and so make them more vulnerable to depression.
47
ABC model
Ellis proposed that depression occurs when an activating event (A) triggers an irrational belief (B) which in turn produces a consequence (C), i.e. an emotional response like depression. The key to this process is the irrational belief.
48
What are the three parts to explaining cognitive vulnerability according to beck
-Faulty information processing
-negative self-schema
-The negative triad
49
Faulty information processing
This is when depressed people attend to the negative aspects of a situation and ignore positives. For example, if I was depressed and won f1 million on the Lottery, I might focus on the fact that the previous week someone had won f10 million, rather than focus on the positive of all I could do with f1 million. Depressed people may tend towards 'black and white thinking' where something is either all bad or all good
50
Negative self-schema
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.
The
51
The negative triad
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, the future and oneself are uppermost.
a) Negative view of the world - an example would be 'the world is a cold hard place. This creates the impression that there is no hope anywhere.
b) Negative view of the future - an example would be 'there isn't much chance that the economy will really get better. Such thoughts reduce any hopefulness and enhance depression.
c) Negative view of the self - for example, thinking 'I am a failure. Such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self esteem
52
What are the three parts of the ABC model
-activating events
-beliefs
-consequences
53
Activating events
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. Events like failing an important test or ending a relationship might trigger irrational beliefs.
54
Beliefs
Ellis identified a range of irrational beliefs. He called the belief that we must always succeed or achieve perfection 'musturbation'. "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.
55
Consequences
When an activating event triggers irrational beliefs there are emotional and behavioural consequences. For example, if a person believes that they must always succeed and then fails at something this can trigger depression.
56
What is a strength of becks negative triad (research support)
-One strength generally of Beck's cognitive model of depression is the existence of supporting research.
-"Cognitive vulnerability' refers to ways of thinking that may predispose a person to becoming depressed, for example faulty information processing, negative self-schema and the cognitive triad. In a review Clark and Beck (1999) concluded that not only were these cognitive vulnerabilities more common in depressed people but they preceded the depression. This was confirmed in a more recent prospective study by Cohen et al. (2019). They tracked the development of 473 adolescents, regularly measuring cognitive vulnerability.
It was found that showing cognitive vulnerability predicted later depression.
This shows that there is an association between cognitive vulnerability and depression.
57
What is a strength of becks negative triad (real world application)
further strength of Beck's cognitive model of depression is its applications in screening and treatment for depression.
Cohen et al. (see above) 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 cognitive vulnerability can also be applied in cognitive behaviour therapy (CBT - see next spread). These therapies work by altering the kind of cognitions that make people vulnerable to depression, making them more resilient to negative life events.
This means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice.
58
What is a limitation of the ABC model (Reactive and endogenous depression)
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. Elli'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.
59
What is a strength of the ABC model (Real-world application)
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.
60
Cognitive behaviour therapy
A method for treating mental disorders based on both cognitive and behavioural techniques. From the cognitive viewpoint the therapy aims to deal with thinking, such as challenging negative thoughts. The therapy also includes behavioural techniques such as behavioural activation.
61
Irrational thoughts
Also called dysfunctional thoughts. In Ellis's model and therapy, these are defined as thoughts that are likely to interfere with a person's happiness. Such dysfunctional thoughts lead to mental disorders such as depression.
62
Beck's cognitive therapy
Cognitive therapy is the application of Beck's cognitive theory of depression (see previous spread). The idea behind cognitive therapy is to identify automatic thoughts about the world, the self and the future - this is 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 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 client's statements are incorrect.
63
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.
-central technique of REBT is to identify and dispute (challenge) irrational thoughts.
E.g-a client might talk about how unlucky they have been or how unfair things seem. An REBT therapist would identify these as examples of utopianism and challenge this as an irrational belief.
-This would involve a vigorous argument.
-The intended effect is to change the irrational belief and so break the link between negative life events and depression.
64
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 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, e.g. exercising, going out to dinner, etc. The therapist aims to reinforce such activity.
65
What is a strength of CBT (evidence for effectiveness)
One strength of CBT is the large body of evidence supporting its effectiveness for treating depression.
Many studies show that CBT works. For example, John 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 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 six 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 National Health Service.
66
What is a limitation of CBT (suitability for diverse clients)
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. Peter Sturmey (2005) suggests that, in general, any form of psychotherapy (i.e. any 'talking' therapy) is not suitable for people with learning disabilities, and this includes CBT.
This suggests that CBT may only be appropriate for a specific range of people with depression.
67
What is a counterpoint to suitability for diverse clients to CBT
Although the conventional wisdom has been that CBT is unsuitable for very depressed people and for clients with learning disabilities, there is now some more recent evidence that challenges this. A review by Gemma Lewis and Glyn Lewis (2016) concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression. Another review by John Taylor et al. (2008) concluded that, when used appropriately, CBT is effective for people with learning disabilities.
This means that CBT may be suitable for a wider range of people than was once thought.
68
What is a limitation of CBT (Relapse rates)
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, Shehzad Ali et al. (2017) 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.
69
Lewis study on OCD
observed that of his patients with OCD, 37% had parents and 21% had siblings with OCD. This suggests that OCD runs in families, although what is probably passed on is a genetic vulnerability
70
Diathesis stress model (OCD)
certain genes leave people more likely to develop a mental disorder but it is not certain. Some environmental stress is necessary to trigger the condition
71
Candidate genes
These have been identified as creating vulnerability for OCD
72
Polygenetic genes
OCD is not caused by one particular gene but instead a combination of genetic variations increasing vulnerability
73
How many genes cause OCD according to Taylor
up to 230 genes may be involved in OCD
74
Candidate gene for OCD
COMT gene
SERT gene
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COMT gene
the COMT gene is responsible for breaking down dopamine and brings your heartbeat down to a normal level and helps you manage stress.
-a variation of the COMT gene results in higher levels of dopamine and this variation of the gene is more common in OCD sufferers
76
How does dopamine levels affect OCD
high levels lead to compulsions because they have too much motivation to carry out the actions
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SERT gene
The SERT gene is linked to the transport of serotonin and causes low levels which is associated with OCD
78
how does low levels of serotonin affect OCD
leads to low mood
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OCD is aetiologically heterogenous
one group of genes may cause OCD in one person but a different group of genes may be the result of OCD in another
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neural explanations (OCD)
physical and psychological characteristics are determined by the behaviour of the nervous system, in particular the brain.
-The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as the structure of the brain
81
The role of serotonin
-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
82
Decision-making systems
-some cases of OCD are associated with impaired decision making
-This in turn may be associated with abnormal functioning of the lateral of the frontal lobes of the brain
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Parahippocampal gyrus
There is evidence to suggest that this arer associated with processing unpleasant emotions, functions abnormally in OCD
84
The worry circuit
In someone with OCD the worry goes to the orbital frontal cortex which goes to the caudate nucleus. However, low levels of serotonin mean the CN can't function properly and the worry continues to the thalamus which allows it to continue. This leads to compulsions
85
A strength of biological explanations of OCD(Research support of biological explanations of OCD)
-One strength of the genetic explanation for OCD is the strong evidence base for OCD being as a result of their genetic make-up.
-Nestadt reviewed twin studies and found that 68% MZ wins shared OCD opposed to 31% non-identical twins.
-Marini and Stebnicki found those with a family member with OCD are 4 times more likely to develop it than someone without.
-This therefore suggests there must be some sort of genetic influence on the development of OCD.
86
A limitation of biological explanations of OCD (Environmental risk factors of OCD)
-A limitation of the genetic explanation is the failure to consider the environmental risk factors.
-There is a strong evidence bases to say some people are more likely to be vulnerable to OCD than others, however we recognise that OCD is not generic in origin and it seems that some environmental factors have a apart to ay.
-Cromer et al found that over half of their OCD clients had experienced a traumatic event – it was also seen to be more severe with those who had suggested more than one trauma.
-This therefore suggests that there are other factors other than genetics which causes OCD posing only a partial explanation.
87
A strength of neural explanations (research support)
-A strength of the neural model is there is some evidence to support this.
-Antidepressants that work purely on serotonin have been provide to reduce OCD, which therefore suggests that serotonin may be involved in OCD.
-OCD symptoms have shown to form part of Parkinson’s disease which is considered a biological disorder. If a biological disorder produces OCD symptoms, then we assume the biological processes causes OCD.
-This therefore suggests that biological factors may be responsible for OCD.
88
A limitation of neural explanations of OCD (No unique explanation)
-A limitation of the neural model is that the serotonin-OCD link is not unique to OCD.
-Many people with OCD also experience clinical depression – having two disorders is called co-morbidity.
-The depression likely involves disruption to the action of serotonin.
-If serotonin is disrupted with people with OCD, as well as those with depression, this suggests that serotonin may not be relevant to OCD symptoms.
89
Drug therapy
Treatment involving drugs, i.e. chemicals that have a particular effect on the functioning of the brain or some other body system. In the case of psychological disorders such drugs usually affect neurotransmitter levels.
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SSRI- OCD treatment
a selective serotonin reuptake inhibitor is an antidepressant drug that (SSRIs) work on the serotonin system in the brain
91
Serotonin in the brain
Serotonin is released by certain neurons in the brain. In particular it 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.
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How do SSRI's work
By preventing 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.
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How does drug therapy treat OCD
Higher levels of serotonin causes the caudate nucleus to block worrying thoughts effectively, leading to a decrease in obsessive thoughts and thus compulsions
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Combining SSRIs with other treatments
Drugs are often used alongside CBT to treat OCD. The drugs reduce a person's emotional symptoms, such as feeling anxious or depressed.
This means that people with OCD can engage more effectively with the CBT.
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Alternatives to SSRIs
Where an SSRI is not effective after three to four months the dose can be increased (e.g. up to 60 mg a day for fluoxetine) or it can be combined with other drugs.
Sometimes different antidepressants are tried
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Tricyclics
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.
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SNRIs
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 levels of serotonin as well as another different neurotransmitter - noradrenaline.
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What is a strength of drug treatment for OCD (evidence for effectiveness)
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. (2009) 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 typically drugs are helpful.
99
What is a counterpoint to evidence of effectiveness for drug treatments of OCD
There is some evidence to suggest that even if drug treatments are helpful for most people with OCD they may not be the most effective treatments available. 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 the treatment of OCD. This means that drugs may not be the optimum treatment for OCD.
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What is a limitation to drug treatments of OCD (serious side effects)
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. blurred vision and loss of sex drive. 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.
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What is a strength of systematic desensitisation (evidence of effectiveness)
One strength of systematic desensitisation (SD) is the evidence base for its effectiveness. Gilroy et al. (2003) 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 fearful than a control group treated by relaxation without exposure. In a recent review Wechsler et al. (2019) concluded that SD is effective for specific phobia, social phobia and agoraphobia. This means that SD is likely to be helpful for people with phobias.
