Psychopathology

Question 1

What is psychopathology?

Answer 1

The study of mental illness/mental distress and abnormal, maladaptive behaviour.

Question 2

What are the four methods of defining abnormality?

Answer 2

1. Statistical deviation.
2. Deviation from social norms.
3. Failure to function adequately.
4. Deviation from ideal mental health.

Question 3

Statistical infrequency

Answer 3

When an individual has a less common characteristic in relation to the rest of the population statistically. For example, those scoring below 70 IQ are statistically abnormal and are diagnosed with an intellectual disability disorder.
✅ real life application: useful part of clinical diagnosis and assessment so is therefore applicable to real life. Most disorders have some sort of statistical measurement. For example, the BDI assesses depression, only 5% of people score 30+ (= severe depression).
❌ makes the assumption that any abnormal characteristics are automatically negative, whereas this is not always the case. E.g. displaying abnormal levels of empathy (thus qualifying as a highly sensitive person) or having an IQ score above 130 would rarely be looked down upon as negative characteristics which require treatment. This means that, although statistical infrequency can be part of defining abnormality, it can never be its sole basis for every disorder.
❌ labelling: labelling is powerful and might effect people in a negative way. If you give people a label, they might start acting in a way that fulfils the label. Some people are abnormal but lead happy and fulfilled lives. If we label someone then we run the risk of developing a self-fulfilling prophecy. In addition, this may have a negative effect on the way others view them and the way they view themselves.

Question 4

Deviation from social norms

Answer 4

Suggests abnormal behaviour is based upon straying away from the social norms specific to a certain culture.
These are general norms, applicable to the vast majority of cultures, as well as culture-specific norms.
❌ Due to its reliance on subjective social norms, this explanation suffers from cultural relativism. One such example would be the hearing of voices which have no basis in reality, or ‘hallucinations’. Some African and Asian cultures in particular would look upon this symptom positively, viewing it as a sign of spirituality and a strong connection with ancestors, as opposed to a symptom of Schizophrenia. This therefore suggests that the use of this definition of abnormality may lead to some discrepancies in the diagnoses of mental health disorders, between cultures.
✅ real-world application. Is useful in the diagnosis of antisocial personality disorder because this requires failure to conform to social standards. Also helpful in diagnosing schizotypal personality disorder which involves ‘strange’ behaviour.
❌ human rights abuses. Reliance on deviation from social norms to understand abnormality can lead to abuse of human rights e.g. nymphomania (a disorder) to control female behaviour. However, we need to be able to use deviation from social norms to diagnose conditions such as antisocial personality disorder. This suggests that, overall, the use of deviation from social norms to define abnormality may do more harm than good because of the potential for abuse.

Question 5

Failure to function adequately

Answer 5

Occurs when someone is unable to cope with ordinary demands of day-to-day living, lack of motivation, and obedience to social norms.
Rosenhan and Seligman proposed further signs of failure to cope. When someone is not coping:
• They no longer conform to interpersonal rules, e.g. maintaining personal space.
• They experience severe personal distress.
• They behave in a way that is irrational or dangerous.
Having a very low IQ is a statistical infrequency but diagnosis would not be made on this basis alone. There would have to be clear signs that the person was not able to cope with the demands of everyday living. So intellectual disability is an example of failure to function adequately.
✅ A major strength of this definition of abnormality is that it takes into account the patient’s perspective, and so the final diagnosis will be comprised of the patient’s (subjective) self- reported symptoms and the psychiatrist’s objective opinion. This may lead to more accurate diagnoses of mental health disorders because such diagnoses are not constrained by statistical limits, as is the case with statistical infrequency.
✅ a step to professional help. In any given year, 25% of us experience symptoms of mental disorder to some degree (Mind). Most of the time we ignore it, but when we fail to function adequately people seek or are referred for professional help. This means that the failure to function criterion provides a way to target treatment and services to those who need them most.
❌ Failure to function can be normal. In some circumstances most of us can’t cope e.g. bereavement. It is unfair to give someone a label for reacting normally to difficult circumstances. Labelling may add to someone’s problems e.g. it would be very ‘normal’ to get depressed after losing someone you love but a permanent label may be attached to that person. However a person may still need professional help to adjust to bereavement. This means it is hard to know when to base judgment of abnormality on failure to function.
❌ many people engage in behaviour that is maladaptive/harmful or threatening to self, but we don’t class them as abnormal. E.g. adrenaline sports, smoking, drinking alcohol, skipping classes. It is hard to distinguish between failure to function and a conscious decision to deviate from social norms. For example, people may choose to live off-grid as part of an alternative lifestyle choice or take part in high-risk leisure activities. This means that people who make unusual choices can be labelled abnormal and their freedom of choice restricted.

Question 6

Deviation from ideal mental health

Answer 6

Deviation from ideal mental health was proposed by Jahoda. Instead of focusing on abnormality, Jahoda looked at what would comprise the ideal mental state of an individual. The criteria include being able to self-actualise (fulfill one’s potential, in line with humanism!), having an accurate perception of ourselves, not being distressed, being able to maintain normal levels of motivation to carry out day-to-day tasks and displaying high self-esteem.
❌ The main issue with this definition of abnormality is that Jahoda may have had an unrealistic expectation of ideal mental health, with the vast majority of people being unable to acquire, let alone maintain, all of the criteria listed. This means that the majority of the population would be considered abnormal, even if they have missed a single criteria e.g. being able to rationally cope with stress (which most people would agree does not merit a diagnosis). Therefore, deviation from ideal mental health may be considered a very limited method of diagnosing mental health disorders.
❌ This definition, just like deviation from social norms, suffers from cultural relativism. For example, the concept of self-actualisation, which suggests that we must each put ourselves first in order to achieve our full potential, may be viewed as selfish in collectivist cultures (e.g. China) where the needs of the group are valued more than the needs of the individual. On the other hand, self-actualisation may be a more popular concept in individualist cultures (e.g. the UK), where personal achievement is celebrated and the needs of the individual are greater than the needs of the group. This suggests that deviation from ideal mental health would only be accepted as a definition for abnormality in some (individualist) cultures.
✅ comprehensive. Ideal mental health includes a range of criteria for mental health. It covers most of the reasons why we might need help with mental health. This means that mental health can be discussed meaningfully with a range of professionals e.g. psychiatrist or CBT therapist. Therefore ideal mental health provides a checklist against which we can assess ourselves and others.

Question 7

Phobia

Answer 7

An irrational fear of an object or situation

Question 8

Behavioural responses to phobias

Answer 8

• Panic —> may involve a range of behaviours such as crying, screaming, or running away from the phobic stimulus. The patient suffers from heightened physiological arousal upon exposure to the phobic stimulus, caused by the hypothalamus triggering increased levels of activity in the sympathetic branch of the autonomic nervous system.
• Avoidance —> considerable effort to prevent contact with the phobic stimulus. This can make it hard to go about everyday life. Is negatively reinforced because it is carried out to avoid the unpleasant consequence of exposure to the phobic stimulus.
• Endurance —> an alternative behaviour to avoidance. Involves remaining with the phobic stimulus and continuing to experience anxiety. This may be unavoidable in some situations, for example for a person who has an extreme fear of flying

Question 9

Emotional responses to phobias

Answer 9

• Anxiety —> an unpleasant state of high arousal. Prevents an individual relaxing and makes it very difficult to experience positive emotion.
• Fear —> the immediate response we experience when we encounter or think about a phobic stimulus.
• Emotional response is unreasonable —> disproportionate to the threat posed, e.g. a person with arachnophobia will have a strong emotional response to a tiny spider.

Question 10

Cognitive response to phobias

Answer 10

• Selective attention to the phobic stimulus —> a person with a phobia finds it hard to look away from the phobic stimulus even when it is causing them severe anxiety. This may be as a result of irrational beliefs or cognitive distortions. Keeping our attention on something really dangerous is a good thing as it gives us the best chance of reacting quickly to a threat, but this is not so useful when the fear is irrational.
• Irrational beliefs —> incorrect perception as to what the danger posed actually is.
• Cognitive distortions —> phobic stimulus is not perceived accurately. Therefore, it may often appear distorted or irrational. For example, someone with gynophobia having a phobia of women and not having a direct cause of the phobia.

Question 11

Depression

Answer 11

A mental disorder characterised by low mood and low energy levels

Question 12

Behavioural characteristics of depression

Answer 12

• Activity levels —> people with depression have reduced levels of energy making them lethargic. This has a knock-on effect, with sufferers tending to withdraw from work, education, and social life. In extreme cases this can be so severe that the sufferer cannot get out of bed. In some cases depression can lead to the opposite effect — known as psychomotor agitation. Agitated individuals struggle to relax and may end up pacing up and down a room.
• Disruption to sleep and eating behaviour —> reduced sleep (insomnia) or an increased need for sleep (hypersomnia). Appetite and eating may increase or decrease, leading to weight gain or loss.
• Aggression and self harm —> aggression towards oneself and towards others.

Question 13

Emotional symptoms of depression

Answer 13

• Lowered mood —> lasting for months at a time and high in severity.
• Anger —> towards oneself and towards others. Leads to aggression or self-harming behaviour
• Lowered self-esteem

Question 14

Cognitive characteristics of depression

Answer 14

• Poor concentration and decision making —> the consequent disruptions to school and work add to the feelings of worthlessness and anger.
• Attention to the negative —> pay more attention to negative aspects of a situation and ignore the positives. A bias towards recalling unhappy events rather than happy ones.
• Absolutist thinking —> when a situation is unfortunate it is seen as an absolute disaster

Question 15

OCD

Answer 15

Condition characterised by obsessions and/or compulsive behaviour.

Question 16

Behavioural characteristics of OCD

Answer 16

• Compulsions are repetitive —> actions carried out repeatedly in a ritualistic way
• Compulsions reduce anxiety —> anxiety may be created by obsessions, however, ~ 10% of sufferers of OCD show compulsive behaviour alone (no obsessions just a general sense of irrational anxiety).
• Avoidance —> OCD is managed by avoiding situations that trigger anxiety, e.g. avoiding rubbish bins because they have germs (negative reinforcement). This can interfere with leading a normal life due to avoiding ordinary situations.

Question 17

Emotional characteristics of OCD

Answer 17

• Anxiety and distress —> obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming. The urge to repeat a behaviour (a compulsion) creates anxiety.
• Depression —> compulsive/repetitive behaviour often interfere with day to day functioning and relationships.
• Guilt and disgust —> irrational guilt (e.g. over minor moral issues), or disgust which is directed at oneself or something else.

Question 18

Cognitive characteristics of OCD

Answer 18

• Obsessive thoughts —> ~ 90% suffers this. Repetitive, focus on the stimulus, intrusive, cause excessive amounts of anxiety, lead to compulsive behaviours.
• Cognitive coping strategies —> some people use strategies to cope e.g. meditation.
• Insight into excessive anxiety —> awareness that thoughts and behaviour are irrational. May have catastrophic thoughts.

Question 19

Behavioural approach fo explaining phobias

Answer 19

• Mowrer argued that phobias are learned by classical conditioning and then maintained by operant conditioning (two process model).
• Classical conditioning involves association:
1. UCS triggers a fear response (fear is a UCR), e.g. being bitten creates anxiety.
2. NS is associated with the UCS, e.g. being bitten by a dog, the dog did not create anxiety precisely.
3. NS becomes a CS producing fear (which is now the CR). The dog becomes a CS causing a CR of anxiety/fear following the bite.
• Watson and Rayner showed how a fear of rats could be conditioned in ‘Little Albert’. Whenever Albert played with a white rat, a loud noise was made close to his ear. The noise (UCS) caused a fear response (UCR). Rat (NS) did not create fear until the bang and the rat had been paired together several times. Albert showed a fear response (CR) every time he came into contact with the rat (now a CS).
• Generalisation of fear to other stimuli. For example, Little Albert showed fear to a Santa Claus beard because it was a white and furry like a rat.
• Maintenance by operant conditioning (negative reinforcement). Operant conditioning takes place when our behaviour is reinforced or punished. Negative reinforcement —> an individual produces behaviour that avoids something unpleasant. When a person with a phobia avoids a phobic stimulus they escape the anxiety that would have been experienced. This reduction in fear negatively reinforces the avoidance behaviour and the phobia is maintained.

Question 20

Behavioural approach to explaining phobias evaluations

Answer 20

✅ Good explanatory power - The main advantage of this theory is that it can explain the mechanism behind the acquisition and maintenance of phobias, which classical or operant conditioning alone cannot do. This translates to practical benefits in systematic desensitisation and flooding. Mowrer emphasises the importance of exposing the patient to the phobic stimulus because this prevents the negative reinforcement of avoidance behaviour. The patient realises that the phobic stimulus is harmless and that their responses are irrational/disproportionate, thus translating into a successful therapy.

✅ real-world application. The idea that phobias are maintained by avoidance is important in explaining why people with phobias benefit from exposure therapies. Once avoidance behaviour is prevented it ceases to be reinforced by the reduction of anxiety. Avoidance behaviour therefore declines. This shows the value of the two-process approach because it identifies a means of treating phobias.

❌ inability to explain cognitive aspects of phobias. Behavioural explanations like the two-process model are geared towards explaining behaviour. However, we know that phobias also have a significant cognitive component. This means that the two-process model does not fully explain the symptoms of phobias.

❌ Alternative explanation for the acquisition of phobias - Seligman suggested that we are more likely to develop phobias towards ‘prepared’ stimuli. These are stimuli which would have posed a threat to our evolutionary ancestors, such as fire or deep water, and so running away from such a stimulus increases the likelihood of survival and reproduction, and so this behaviour has a selective evolutionary advantage. This means that alternative theories can explain why some phobias are much more frequent than other phobias.

❌ sometimes phobias appear following a bad experience and it is easy to see how they could be the result of conditioning. However, sometimes people develop a phobia and are not aware of having a related bad experience. This limits the use of the behavioural approach as an explanation of all behaviours.

Question 21

What is systematic desensitisation?

Answer 21

A behavioural therapy designed to reduce phobic anxiety through gradual exposure to the phobic stimulus.

Question 22

Systematic desensitisation process

Answer 22

• Relies on counter-balancing: learning a new response to the phobic stimulus (relaxation rather than panic). Relaxation becomes the new conditioned response.
• Works due to reciprocal inhibition: it’s impossible to be both relaxed and anxious at the same time, so one emotion prevents the other.
• First, the patient and therapist draw up an anxiety hierarchy together, made up of situations involving the phobic stimulus, ordered from least to most nerve-wrecking.
• The therapist then teaches the patient relaxation techniques (e.g. breathing techniques and meditation) to be used at each of these anxiety levels.
• The patient works their way up through the hierarchy, only progressing to the next level when they have remained calm in the present level. The phobia is cured when the patient can remain calm at the highest anxiety level.

Question 23

Systematic desensitisation evaluations

Answer 23

✅ supporting research. Gilroy et al. followed up 42 patients treated in three sessions of systematic desensitisation for a spider phobia. Their progress was compared to a control group of 50 patients who learnt only relaxation techniques. The extent of such phobias was measured using the Spider Questionnaire and through observation. At both 3 and 33 months, the systematic desensitisation group showed a reduction in their symptoms as compared to the control group, and so has been used as evidence supporting the effectiveness of flooding.

✅ suitable for many patients, including those with learning difficulties. Anxiety disorders are often accompanied with learning disabilities meaning that such patients may not be able to make the full cognitive commitment associated with cognitive behavioural therapy, or have the ability to evaluate their own thoughts. Therefore, systematic desensitisation would be a particularly suitable alternative for them.

✅ more acceptable to patients, as shown by low refusal rates. Has economical implications because it increases the likelihood that the patient will agree to start and continue with the therapy, as opposed to wasting the time and effort of the therapist. Those given choice of systematic desensitisation or flooding tend to prefer systematic desensitisation — this is largely because it does not cause the same degree of trauma as flooding and involves relaxation.

✅ the exposure part of SD can be done in virtual reality which avoids dangerous situations (e.g. heights) and is cost-effective.
❌ may be less effective than real exposure for certain phobias because it lacks realism.
This means that SD using VR is sometimes but not always appropriate.

Question 24

What is flooding?

Answer 24

Flooding is a behavioural therapy designed to reduce phobic anxiety in one session, through immediate exposure to the phobic stimulus. This occurs in a secure environment from which the patient cannot escape. Without the option of avoidance behaviour, the person quickly learns that the phobic stimulus is harmless through the exhaustion of their fear response (extinction). Or, a learned response comes when the conditioned stimulus (e.g. dog) is encountered without the unconditioned stimulus (e.g. being bitten) and as a result the conditioned stimulus no longer produces the conditioned response (fear). People being treated must give informed consent.

Question 25

Flooding evaluations

Answer 25

✅ Cost-effective. Ougrin compared flooding to cognitive therapies and found it to be cheaper. This is because the patient’s phobia will typically be cured in one session, thus freeing them of their symptoms and allowing them to continue living a normal life.

❌ less effective for some types of phobias. Although flooding is highly effective for treating simple phobias it appears to be less so for more complex phobias like social phobias. This may be because social phobias have cognitive aspects. For example, a sufferer of a social phobia does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation. This type of phobia may benefit more from cognitive therapies because such therapies tackles irrational thinking.

❌ can be a highly traumatic experience. It is not that flooding is unethical because patients give consent, but rather the patients are unwilling to see it through to the end. This is a limitation of flooding because time and money are sometimes wasted preparing patients only to have them refuse to start or complete treatment.

❌ a common criticism of both systematic desensitisation and flooding is that when one phobia disappears another may appear in its place. For example, a phobia of snakes might be replaced by a phobia of trains. Evidence for symptom substitution is very mixed, however, and behavioural therapists tend not to believe it happens at all.

Question 26

Beck Negative Triad

Answer 26

Faulty information processing —> Beck suggested that some people are more prone to depression because of faulty information processing.
People who are depressed attend to the negative aspects of a situation and ignore positives, they also tend to blow small problems out of proportion.
Negative self-schema. A schema is a ‘package’ of ideas and information developed through experience. Someone with a negative self-schema interprets all information about themselves in a negative way.
The negative triad —> negative view of world, future, self.

Question 27

Beck’s negative triad evaluations

Answer 27

✅ Beck’s cognitive explanation forms the basis of CBT (real-wold application). All cognitive aspects of depression can be identified and challenged in CBT. These include the components of the negative triad that are easily identifiable. This means a therapist can challenge them and encourage the patient to test whether they are true. This is a strength of the explanation because it translates well into a successful therapy.

❌ Beck’s theory explains neatly the basic symptoms of depression, however depression is complex. Some depressed patients are deeply angry and Beck cannot explain this extreme emotion. Some sufferers of depression suffer hallucinations and bizarre beliefs, Beck’s theory cannot easily explain these cases.

❌ doesn’t explain origins of irrational thoughts. It is possible that other factors, for example genes and neurotransmitters, are the cause of depression and one of the side effects of depression are negative, irrational thoughts. Research has found a link in the role of the neurotransmitter serotonin and found lower levels in patients with depression. In addition, drug therapies, including SSRI’s, which increase the level of serotonin, are found to be effective in the treatment of depression, which provide further support for the role of neurotransmitters in the development of depression.

Question 28

Ellis ABC model

Answer 28

Activating event: depression occurs when we experience negative events.
Beliefs: negative events trigger irrational beliefs. Musterbation = belief we must always succeed or achieve perfection. ‘I-can’t-stand-it-itis’ = belief that it is a disaster when things do not go smoothly. Utopianism = belief that the world must always be fair and just.
Consequences: when an activating event triggers irrational beliefs there are emotional and behavioural consequences.

Question 29

Ellis ABC model evaluations

Answer 29

✅ has application to therapy. Has been used to develop effective treatments for depression, including CBT and REBT, which was developed from Ellis’s ABC model. These therapies attempted to identify and challenge negative, irrational thoughts and have been successfully used to treat people with depression, providing further support to the cognitive explanation of depression.

❌ doesn’t explain all aspects of depression, just like Beck’s. Although Ellis explains why some people appear to be more vulnerable to depression than others as a result of their cognitions, his approach has very much the same limitation as Beck’s. It doesn’t easily explain the anger associated with depression or the fact that some patients suffer hallucinations and delusions. It only explain reactive depression (form of depression which is triggered by negative activating events).

❌ ethical issues. The ABC model of depression locates responsibility for depression with the depressed person. Critics see this as blaming the depressed person.
✅ However, the application of the ABC model to REBT does appear to make at least some depressed people achieve more resilience and feel better.
This means REBT gives reasons for concern but can be ethically acceptable as long as it is carried out sensitively to avoid victim-blaming.

Question 30

Cognitive behaviour theory (CBT)

Answer 30

• Most common psychological treatment for depression.
• Begins with an assessment where the patient and therapist work together to clarify the patient’s problems.
• One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge. CBT then involves working to change these and put more effective behaviours in place.
• Beck’s cognitive therapy: identifies the negative triad. These thoughts must be challenged. The ‘client as a scientist’ meaning they are encouraged to test the reality of their irrational beliefs. They might be set homework, e.g. to record when people were nice to them, in future sessions if client says that no one is nice to them the therapist can produce this evidence to prove the client’s beliefs are incorrect.
• Ellis’s rational emotive behaviour theory (REBT). Extends the ABC model to an ABCDE model — D for dispute (challenge) irrational beliefs, E for effect. Empirical argument —> disputing whether there is evidence to support the irrational belief. Logical argument —> disputing whether the negative thought actually follows from the facts.
• Behavioural activation —> therapist may also encourage a depressed patient to be more active and engage in enjoyable activities.

Question 31

Cognitive behaviour therapy evaluations

Answer 31

✅ large body of evidence supporting its effectiveness for treating depression. March et al. compared CBT to antidepressant drugs and also to a combination of both treatments. Both the drugs and CBT had 81% improvement, so CBT was just as effective when used on its own and more so when used alongside antidepressants (86%). CBT is usually a fairly brief therapy requiring 6 to 12 sessions so it is also cost-effective.
This means that CBT is widely seen as the first choice of treatment in public health care systems such as NHS.

❌ alternative treatments are available. The most popular treatment for depression is the use of antidepressants such as SSRIs. Drug therapies have the strength of requiring less effort on the part of the client. They can also be used in conjugation with a psychotherapy such as CBT. This may be useful because a distressed client may be unable to focus on the demands of CBT and the drug treatment could enable them to cope better.
❌ lack of effectiveness for severe cases as patients cannot motivate themselves to engage with the hard cognitive work of CBT. They may not even be able to pay attention to what is happening in a session or may not be able to turn up to the session due to not being able to get out of bed in the morning. They may feel they are beyond help.
✅ Where this is the case it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated.
❌ although this is a limitation because it means CBT cannot be used as the sole treatment for all cases of depression and cannot be used solely for cases which need help the most.

❌ 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 studies of CBT for depression looked at long-term effectiveness.

Question 32

Genetic explanation

Answer 32

• Researchers have identified specific genes which create a vulnerability for OCD, called candidate genes. These are serotonin genes and dopamine genes. Serotonin genes are implicated in the transmission of serotonin across synapses. Dopamine genes are also implicated in OCD and may regulate mood. Both dopamine and serotonin are neurotransmitters.
• Polygenetic. OCD is not caused by one single gene but several genes are involved. Taylor found evidence that up to 230 different genes may be involved in OCD.
• Different types of OCD: one group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person (aetiologically heterogeneous).

Question 33

Genetic explanation evaluations

Answer 33

✅ good supporting evidence. One of the best sources of evidence for the importance of genes is twin studies. Nestadt et al. reviewed previous twin studies and found 68% of identical twins shared OCD as opposed to 31% of non-identical twins. This suggests a genetic influence on OCD but not determined by genetics otherwise studies would show 100% for identical twins.

❌ too many candidate genes. Although twin studies strongly suggest that OCD is largely under genetic control, psychologists have been much less successful at pinning down all the genes involved. One reason for this is because it appears that several genes are involved and that each genetic variation only increases the risk of OCD by a fraction. The consequence is that a genetic explanation is unlikely to ever be very useful because it provides little specific value of the genes.

❌ it seems that environmental factors can also trigger or increase the risk of developing OCD. For example, Cromer et al. found that over half the OCD patients in their sample had a traumatic event in their past, and that OCD was more severe in those with more than one trauma. This suggests that OCD cannot be entirely genetic in origin, at least not in all cases. It may be more productive to focus on the environmental causes because we are more able to do something about these.

Question 34

Neural explanations

Answer 34

• Low levels of serotonin lowers mood. Neurotransmitters are responsible for relaying information from one neuron to another. If a person has low levels of serotonin then normal transmission of mood-relevant information does not take place and mood is affected.
• Some cases of OCD seem to be associated with impaired decision-making. This in turn may be associated with abnormal functioning of the lateral frontal lobes of the brain. The frontal lobes are responsible for logical thinking and making decisions.
• There is also evidence to suggest that an area called the left paraphippocampal gyrus is associated with processing unpleasant emotions, functions abnormally in OCD.

Question 35

Neural explanation

Answer 35

✅ supporting evidence. There is evidence to support the role of some neural mechanisms in OCD. E.g. some antidepressants work purely on the serotonin system, increasing levels of this neurotransmitter. These drugs are effective at reducing OCD symptoms and this suggests that the serotonin system is involved in OCD. Also, OCD symptoms form part of conditions that are known to be biological in origin e.g. Parkinson’s disease. This means that biological factors (e.g. serotonin and processes underlying Parkinson’s disease are likely to be involved in OCD.

❌ correlation and causation. we cannot assume the neural mechanisms cause OCD. There is evidence to suggests that various neurotransmitters and structures of the brain do not function normally in patients with OCD. However, this is not the same as saying that this abnormal functioning causes the OCD. These biological abnormalities could be a result of OCD rather than its cause.

❌ many people with OCD also experience depression. This depression probably involves disruption to the action of serotonin. It could simply be that serotonin activity is disrupted in many people with OCD because they are depressed as well. This means that serotonin may not be relevant to OCD symptoms.

Question 36

Drug therapy

Answer 36

• Changing levels of neurotransmitters. Drug therapy for mental disorders aims to increase or decrease levels of neurotransmitters in the brain or to increase/decrease their activity.
• Selective serotonin reuptake inhibitors (SSRIs) prevent the reabsorption and breakdown of serotonin in the brain. This increases its levels in the synapse and thus serotonin continues to stimulate the postsynaptic neuron — this compensates for whatever is wrong with the serotonin system in OCD.
• If you combine SSRI’s and CBT, the drugs reduce a person’s emotional symptoms which means they can engage more effectively with CBT.
• Tricyclics are sometimes used which are an older type of antidepressant, they have the same effect on the serotonin system as SSRIs but the side-effects can be more severe.
• SNRIs are a newer antidepressant drug used to treat OCD. Like tricyclics, they are a second line of defence for people who don’t respond to SSRIs. SNRIs increase levels of serotonin as well as noradrenaline.

Question 37

Drug therapy evaluations

Answer 37

✅ drugs are cost-effective and non-disruptive to patients lives. Using drugs to treat OCD is therefore good value for the NHS. Patients can take the drugs until their symptoms decline and not engage with the hard work of psychological therapy. Therefore, patients and health care systems like drug treatments for these reasons.

❌ drugs can have side effects and for some there will not be the desired effect. Some patients suffer side-effects such as indigestion, blurred vision, loss of sex drive. Although, these side effects are usually temporary. You can also suffer erection problems, tremors, weight gain, aggression. These factors reduce effectiveness because people stop taking the medication.

❌ unreliable evidence for drug treatments. Although SSRIs are fairly effective and any side-effects will probably be short term, like all drug treatments they have some controversy attached. For example, some psychologists believe the evidence favouring drug treatments is biased because the research is sponsored by drug companies who do not report all the evidence.

❌ some cases of OCD follow trauma. OCD is widely believed to be biological in origin. It makes sense, therefore, that the standard treatment should be biological. However, it is acknowledged that OCD can have a range of other causes, and that sometimes this due to a traumatic life event. These cases should be treated with therapy rather than drugs.