Psychopathology

Question 1

Outline the statistical infrequency definition of abnormality

Answer 1

An individual can be classified as abnormal if they display behaviours that are extremely rare.
On a normal distribution curve, individuals who fall 2 standard deviation points away from the mean (approx. 5% of a population) are regarded as abnormal.

Question 2

Outline the failure to function adequately definition of abnormality

Answer 2

Failure of function adequately
* People are judged on their ability to go about daily life—eating regularly, washing regularly, holding down a job etc.
* If they are unable to function adequately and they are distressed, or others are distressed by their behaviour, then it is considered a sign of abnormality
* DSM includes an assessment of ability to function which considers 6 areas (e.g. self-care) and provides a score out of 180.

Question 3

Outline the deviation from ideal mental health definition of abnormality

Answer 3

Deviation from ideal mental health
* Person’s behaviour is measured against a check list of ideal psychological characteristics
* This judges mental health in the same way as physical health, a person requires certain attributes to be mentally healthy.
* Jahoda identified 6 characteristics (Acryonym: SSAARM): self attitudes, self actulisation, autonomy, accurate perception of reality, resistance to stress and mastery of the environment.

Question 4

Outline the deviation from social norms definition of abnormality

Answer 4

• Anyone who contravenes societal expectations of how one should act (i.e socially created norms/ standards of behaviour) is considered abnormal
• These norms are created by a group or society
• Some rules are implicit whereas others are laws—for example, not laughing at a funeral = implicit, whereas murder = illegal

Question 5

Evaluate the failure to function adequately definition of abnormality

Answer 5

• Strength – objective to judge via World Health Organisation Disability assessment - consideres 6 areas that constitute normal function (e.g. self care and understanding and communicating). Individual rate each catagory 1-5 and given score out of 180 - a quantative measure of functioning.
• Abnormality is not allways accompanies by dysfunction - Psychopaths like Harold Shipman murdered estimated 250 patients over a 23-year period, yet appeared like a normal mild-mannered doctor for most of his career.
• Culturally relative – based upon western cultures ideals and beliefs = may only be applied to those individuals

Question 6

Define cognitive biases

Answer 6

Systematic errors in thinking that occur when people process and interpret information in their surroundings, influencing their decisions and judgments. E.g. overgeneralisation

Question 7

Give two examples of cognitive biases

Answer 7

• Overgeneralisation - sweeping conclusions drawn on the basis of one event
• Arbitrary inference - conclusions drawn in the absence of sufficient evidence.

Question 8

Distinguish between obsessions and compulsions

Answer 8

Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease distress.

Question 9

Outline the emotional, behavioural and cognitive charicteristics of phobias

Answer 9

EMOTIONAL
* Anxiety – classified as an anxiety disorder – unpleasant state of high arousal
* Emotional responses are unreasonable – out of proportion to the actual danger e.g. Panic - including crying, screaming or running away
BEHAVIOURAL
* Avoidance – avoid coming into contact with phobia
* Disruption of functioning – including working and social
COGNITIVE
* Irrational belief – e.g. phobia will kill them
* Selective attention to phobic stimulus – hard to look away
* Cognitive distortion – perception of stimulus may be distorted by logical errors

Question 10

Outline the emotional, behavioural and cognitive charicteristics of depression

Answer 10

Emotional
*Lowered mood – sadness and feelings of emptiness
* Lowered self esteem – sense of loathing and hatred
* Anger – can be directed at self or others
Behavioural
* Activity levels – reduced energy levels, or psychomotor agitation (unable to relax)
* Disruption to sleep and eating – reduced sleep (insomnia) or increased sleep (hypersomnia)
* Aggression and self harm – may become verbally or physically
Cognitive
* Dwelling on the negative – ignores positives
* Absolutist thinking – black and white thinking ‘all bad’
* Poor concentration – unable to focus on tasks and find it difficult to make decisions

Question 11

Outline the emotional, behavioural and cognitive charicteristics of OCD

Answer 11

Emotional
* Anxiety and distress – obsessive thoughts are unpleasant and frightening
* Guilt and disgust – irrational guilt
* Accompanying depression – low mood
Behavioural
* Compulsion – repetitive behaviors or mental acts that a person feels driven to perform in order to reduce anxiety caused by an obsession
* Avoidance – avoid situations that can trigger anxiety. This may hinder every day functioning
Cognitive
* Obsessive thoughts – are recurrent and intrusive
* Insight into anxiety – suffers are aware their obsessions and compulsions are not rational

Question 12

Outline the Behavioural approach to explaining phobias

Answer 12

Two process model
Hobart Mowrer (1960) proposed the two-process model based on the behavioural approach. This states that the phobias are:
1. acquired by classical conditioning - associating a previously neutral stimulus with a fear response
2. and then continue/maintained because of operant conditioning - where avoiding or escaping from a feared object/situation acts as a negative reinforcer (this reduces anxiety thus avoids unpleasant state = this is rewarding making it more likely to occur again

Key study – Little albert. Watson and Raynor (1920)
* 11 month old named ‘Little Albert’
* No fear response to white fluffy objects
* Created a conditioned response to these previously neutral objects by making loud noise behind Albert’s head every time he went near a white rat
* They repeated this until whenever the rat was shown to Albert he would cry because he associated the rat with a loud and frightening noise – they had conditioned a fear response in him. He then generalised this to other similar stimulus (stimulus generalisation)

Question 13

Evaluate the behavioural approach to explaining phobias

Answer 13

• Strength - Good explanatory power - people with phobias often recall a specific incident when their phobia first appeared (Sue et al)
• Weakness – cannot explain people who cannot recall a traumatic incident with phobia – a better explanation is biological preparedness: Martin Seligman (1970) argued that humans and animals are genetically programmed to rapidly learn an association between potentially life-threatening stimuli and fear (‘Ancient fears’). For example Bregman (1934) failed to condition a fear response in infants aged 8 to 16 months by pairing a loud bell with wooden blocks.
• RLA—systematic desensitisation - based on classical conditioning
• Weakness - Ignores cognitive factors for example the role of irrational thinking. CBT that challenges irrational thinking has been very successful when treating phobias (Engles et al) = thus behavioural explanation for phobias is a reductionist approach

Question 14

Outline Systematic Desensitisation (Behavioural approach to treating phobias)

Answer 14

Systematic desensitisation
* Developed by Wolpe
* Based upon counterconditioning: responding to a stimulus with fear, changes to responding with relaxation. Forming a new association that runs counter to the original association.
1. Relaxation The therapist teaches the patient to relax as deeply as possible (Reciprocal inhibition - relaxation and anxiety cannot simultaneously co-exist)
2. Desensitisation hierarchy: Therapist and patient construct a series of imagined anxiety provoking situations.
3. Gradual Exposure - Finally the patient is exposed to the phobic stimulus while in a relaxed state. They work through the hierarchy, relaxing and mastering each stage before moving on to the next

In vivo desentisation (confront fear directly)
In vitro/Covert desentisation (imagine feared stimulus)

Question 15

Evaluate Systematic Desensitisation (Behavioural approach to treating phobias)

Answer 15

• Research support: SD is successful for a range of disorders - McGrath et al. (1990) reported that about 75% of patients with phobias respond to SD. The key to success appears to lie in actual contact with the feared stimulus, and therefore in vivo techniques are more successful
• Strength - Relatively fast and require less effort on the patients part (compared to CBT), can be self-administered, ‘lack of thinking’ useful for people who lack insight into motivation/emotions (learning disabilities)
• Weakness - Ohman et al. (1975) suggest that SD may not be as effective in treating phobias that have an underlying evolutionary survival component (ancient fears) e.g. dark, height, snakes = SD will not be useful for innate phobias
• Symptom substitution - SD targets the symptoms, not the cause of phobias of all phobias. Biological predisposition?

Question 16

Outline Flooding (Behavioural approach to treating phobias)

Answer 16

Flooding
* involves a single exposure in non-graded manner to the person’s most feared situation with the phobic object until extinction occurs.
* Taught relaxation techniques, but shown phobic stimulus with non-graded manner
* Adrenaline released when the fear response occurs has a time limit. As adrenaline levels naturally decrease, a new stimulus- response link is learned between the feared stimulus and relaxation.

Question 17

Evaluate Flooding (Behavioural approach to treating phobias)

Answer 17

• Strength – flooding is an effective treatment that is relatively quick compared to CBT (Ougrin, 2011)
• Choy et al. (2007) report that both flooding and SD were effective, but flooding was more effective out of the two at treating phobias
• Less effective for some types of phobias – social phobias (due to them having cognitive aspects)
• Flooding is not for everyone as it can be a highly traumatic procedure. Therefore, they may quit half way through which reduces the effectiveness of the treatment

Question 18

Outline the cognitive approach to explaining depression

Answer 18

Depression is the result of maladaptive/faulty thinking
Ellis’ ABC model
* Irrational beliefs lead to negative interpretation of events
* Activating event (A) - Irrational belief (B) - Unhealthy emotion (C)
* The source of irrational beliefs in masturbatory thinking, thinking that certain ideas or assumptions must be true in order for an individual to be happy e.g. I must be approved of by important people
Becks negative triad
* Depressed people have acquired a negative schema (cog framework) during childhood
* Schemas can become distortions, these lead to cognitive biases such as Overgeneralisation - making a sweeping conclusion on the basis of a single event
* Negative schemas, together with cognitive biases, maintain the negative triad (irrational view of the self, world and future)

Question 19

Evaluate the cognitive approach to explaining depression

Answer 19

• Support for irrational beliefs as cause - Krantz (1976) found depressed participants made more errors in logic when asked to interpret written material than non-depressed participants. Boury et al. (2001) monitored students’ negative thoughts with BDI, finding that depressives misinterpret facts and experiences in a negative fashion and feel hopeless about the future, giving support to Beck’s cognitive explanation.
• Real life application – CBT has been successful in treating people with depression (Ellis 90%)
• Stregnth and weakness - Blames the client rather than situational factors. This can give the client the power to change, or it can be more detrimental. The therapist could overlook situational factors that are affecting the mental disorder (such as life events or family problems).
• Are all irrational beliefs irrational - ‘Sadder but wiser effect’: depressed people can give more accurate estimates of the likelihood of a disaster (Alloy and Abrahmson, 1979)
• Alternative explanations—such as the biological approach, low levels of serotonin have been linked to depression. Successful drug treatments suggest depression is a result in some part from our biology.

Question 20

Outline the cognitive approach to treating depression

Answer 20

**Cognitive behavioural therapy **
CBT has both cognitive and behavioural aspects.
* Cognitive element = dysfunctional thinking, unwanted thoughts
* Behavioural element = the behaviour in response to those thoughts
Ellis developed REBT - Rational emotional behaviour therapy. It aims to challenging irrational thoughts and turn then into rational ones
· Ellis extended his ABC model to ABCDEF D = disputing, E = effects of disputing, F = feelings
Effective disputing changes self-defeating beliefs into more rational beliefs. 3 types of disputing:
* Logical disputing – e.g. does thinking this way make sense?
* Empirical disputing – e.g. where is the proof that this belief is right?
* Pragmatic disputing – e.g. how is this belief likely to help me?

Homework - Clients are given homework assignments, for example going on a date if they had been afraid to do so before/looking for a new job/keep a diary etc. Homework is vital in testing irrational beliefs against reality and putting new rational beliefs into practice

Behavioural Activation - Encourages clients to be more active and engage in pleasurable activities. Based on the idea that being active leads to rewards that act as an antidote to depression (e.g. endorphins)

Unconditional positive regard - Convincing the client that they are a valuable human being. If the client feels worthless they are less likely to try and change their beliefs and behaviour

Question 21

Evaluate the cognitive approach to treating depression

Answer 21

• Research support: Ellis claimed a 90% success rate for REBT taking an average of 27 sessions to complete the treatment and March et al. (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with a main diagnosis of depression. After 36 weeks 81 % of the CBT group, 81 % of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved.
• Implications for the economy – although expensive initially, the long term effectiveness means people will be less likely to take time off of work
• Weakness – not always effective – 1. could be due to some clients not putting their revised beliefs into action and therapist competence (which could account for as much as 15% of the variance in effectiveness - Kuyken and Tsivrikos, 2009) 2. Individual differences - Elkin et al (1985)- not suitable for people who are rigid and/or resistant to change.
• Ignores environmental factors - CBT fails to address the irrational environments that patients are in and continue to be in beyond treatment e.g. bad marriages. (Simons et al, 1995) CBT less suitable for people in situation of high levels of stress that therapy cannot resolve
• Alternative treatments—drug therapy - Cuijpers et al. (2013) found that CBT is especially effective if it is combined with drug therapy, suggesting that clients who are unable to cope with CBT’s demands may cope better if they have drug therapy, too.

Question 22

Outline the Genetic explanation for OCD (Biological approach)

Answer 22

Genetic explanation
COMT Gene
* COMT regulates the production of the neurotransmitter dopamine which has been implicated in OCD
* One form of the COMT gene has been found to be more common in OCD patients
* This variation produces lower activity of the COMT gene and higher levels of dopamine

SERT Gene
* Also known as 5-HTT
* Affects the transport of serotonin, creating lower levels of this neurotransmitter
* A mutation of this gene has been found in two unrelated families where six of the seven members had OCD (Ozaki et al)

Question 23

Outline the neural explanation for OCD (Biological approach)

Answer 23

Neural explanation - Abnormal levels of neurotransmitters
High dopamine levels and OCD
* High doses of drugs that enhance levels of dopamine induced stereotyped movements resembling the compulsive behaviours found in OCD

Lower levels of serotonin associated with OCD
* Antidepressant drugs that increase serotonin activity have been shown to reduce OCD symptoms, whereas antidepressants that have less effect on serotonin do not reduce OCD symptoms
* Serotonin also plays role in operation of OFC and CN (Comer).

Abnormal brain circuits
* Several areas in the frontal lobes of the brain are thought to be abnormal in people with OCD
* The orbitofrontal cortex (OFC) sends worry signals to thalamus – if caudate nucleus is damaged these signals not suppressed – thalamus is alerted & sends signals back to OFC (worry circuit)
* PET scans show a heightened activity in the OFC for OCD patients when their symptoms are active

Question 24

Evaluate the biological approach to explaining OCD

Answer 24

• Research support family and twin studies: Nestadt et al (2000) found that people with first-degree relatives with OCD had a 5x greater risk of having the illness themselves. A meta-analysis of 14 twin studies found that MZ twins were more than twice as likely to develop OCD if their co-twin had the disorder compared to DZ twins (Billet et al., 1998)
• Real-world application: It is presumed that there is a simple relationship between a disorder and genes/areas of brain which has led to the mapping of the human genome, screening fertilised eggs, gene therapy, MRI scans to detect risk etc. However, this is not the case and human genome mapping raises lots of ethical issues
• Weakness - Twin and family may also be more similar in terms of shared environments (compared to non-identical twins who have quite different experiences, one boy one girl). Thus the outcome of OCD is a result of their environment not genes. This is further supported by the fact that concordance rates are never 100% = biological approach to OCD is reductionist
• Alternative explanations— the two-process model - NS associated with anxiety, this association is maintained due to avoidance. This has been supported by the success of treatment ERP – exposure and response prevention

Question 25

Outline the biological approach to treating OCD

Answer 25

• SSRIs – Antidepressant drugs like SSRIs (selective serotonin reuptake inhibitors) elevate levels of serotonin, causing the orbital frontal cortex to function at more normal levels.
  SSRIs work on the brain’s serotonin system. Serotonin is released by the presynaptic neurons and travels across the synaptic cleft to the postsynaptic neuron, chemically conveying a signal as it does so. Normally, serotonin is then reabsorbed, broken down and re-used by the post synaptic neuron. However, SSRIs prevent the reabsorption of serotonin, increasing levels within the synapse so the post synaptic neuron continues to be stimulated. This helps compensate for the improper function of the patient’s serotonin system.
  Tricyclics - such as Clomipramine are an older type of antidepressant usually used when SSRIs are not effective after 3-4 months due to its more severe side effects. Or SSRI dosage increased (e.g. up to 60mg a day for Fluoxetine) or combined with other drugs. Tryclics work similarly to SSRIs – i.e. block the transporter mechanism that re-absorbs both serotonin and noradrenaline into the pre-synaptic cell after it has fired. Thus more serotonin left in synaptic cleft – prolonging its activity and easing transmission of next impulse.
  Benzodiazepine (BZs) – anti-anxiety drug, which enhances the activity of Gamma-aminobutyric acid (GABA), a neurotransmitter which has a general calming effect on brain activity. BZs react with GABA receptors on the outer of a receiving neuron, making it harder for the neuron to be stimulated by other neurotransmitters. Thus, neurons activity is slowed down – inducing feelings of relaxation.

Question 26

Evaluate the biological approach to treating OCD

Answer 26

● Soomro et al. (2009) – reviewed studies comparing SSRIs to placebos – concluded all 17 studies showed significantly better outcomes for SSRI condition. Typically, symptoms decline for 70% of SSRI users. Alternative drug and/or cognitive treatments like CBT are effective for some of the remaining 30%. Thus, helps to improve patients quality of life – reduced absenteeism – economic benefits.
● Maina et al (2011) – found patients relapsed within a week if drug treatments stopped. Thus, drug treatments should be used alongside cognitive behavioural therapy (CBT). Drugs can reduce a patients emotional symptoms (e.g. anxiety), thus helping them to engage more effectively in CBT. Thus, drugs not effective as standalone treatment as not a long term cure.
● More accessible than CBT. Drugs require little effort from user compared to CBT. Accessible to people who lack ability to analyse their own thoughts in CBT. Also, cheaper in short term as patient requires little monitoring – but people can become reliant on antidepressant drugs so the cost builds in the longer term.
● Soomro at al 2009 –identified nausea, headaches, and insomnia as common side effects of SSRIs. Indigestion, blurred vision and loss of sex-drive are other side effects – usually temporary. Tricyclic’s can have more severe side effects – more than 1 in 10 patients suffer hallucinations, tremors, erection problems and weight gain. More than 1 in 100 become aggressive, suffer disruption to blood pressure and heart rhythm. This may lead patients to stop taking the drugs, making them ineffective.
Ineffective – drug treatments average 50% effectiveness. OCD may be caused by cognitive factors and traumatic life events – meaning that drug treatments are ineffective.
● Publication bias – Turner et al. (2008) – claims that there is evidence of publication bias towards studies of antidepressant drugs with a positive outcome – exaggerating their benefits. Studies that were not positive, often published to convey a positive outcome. Drug companies have a financial interest in the continued success of psychotherapeutic drugs and thus fund research in this area