Psychopathology Flashcards
What are the four definitions of abnormality?
failure to function
statistical infrequency
deviation from social norms
deviation from ideal mental health
What is statistical infrequency?
any relatively usual behaviour or characteristic can be thought of as normal (if statistically are normal) or abnormal is the static or occurrences is irregular (statistical infrequency)
What is an example of statistical infrequency?
IQ and intellectual disability disorder
How does statistical approach come in?
comes in when dealing with characteristics that can be reliably measured (e.g. intelligence) Normal distribution is where you go above or below average and the further you go the fewer the people will attain the score
What is the average IQ?
Average IQ is 100. In normal distribution most (68%) have score ranging in-between 85-115, only 2% have below 70. Those individuals are abnormal and are liable to receive diagnosis of a psychological disorder
What are the real world applications of statistical infrequency in definitions of abnormality?
statistical infrequency used in clinical practise for formal diagnosis and assessing severity of symptoms. For example used in assessment for beck Depression inventory (BDI) Score 30+ seen as severe depression
shows value of statistical infrequency criterion is useful in diagnostic and assessment process
What for statistical infrequency is the limitation?
Unusual characteristics can be positive
For everyone below 70 IQ there is above 130. yet would not think high IQ as abnormal. Similarly would not think of someone with low BDI score as abnormal . Shows being unusual of at one end of spectrum does not make you abnormal
Means although statistical infrequency can form part of assessment and diagnostic procedure it is never sufficient for defining abnormalities
What is the extra evaluation for statistical infrequency?
some unusual people benefit from being classed as abnormal but on other hand not all statistically unusual people benefit from labels due to social stigma
What are deviations from social norms?
Most notice when behaviour represents a deviation from social norm. Groups of people choose to define behaviour as abnormal on basis that it offends their sense of what is acceptable (normal)
What are norms that are specific to the culture we live in?
social norms may be different for each generation and different in every culture so few behaviours that are considered abnormal universally that breaches social norms
What is an example of a deviation from social norms?
Antisocial Personality Disorder
What is the anti social personality disorder?
is an impulsive, aggressive and irresponsible person. According to DSM-5 (manual used by psychiatrists to diagnose mental disorders) Important symptoms is ‘absence of prosocial internal standards associated with failure to conform to lawful and culturally normative ethical behaviour’. Other words social
What is the real world application of deviation from social norms?
deviation from social norms used in clinical practises. For example key defining characteristics of certain disorders. These signs of disorders are all deviations from social norms. Also used to diagnose schizophrenia where ‘strange’ is used to characterise thinking, behaviours, etc.
this shows that the deviations from social norms criterion has values in psychiatry
How is cultural and situational relativism a limitation of deviation from social norms for abnormality?
a person from one cultural group may label someone as abnormal using their standards. Social norms differ from one situation to another. Aggressive and deceitful behaviour in the context of family life is more societally unacceptable than in corporate deal making
mean it is difficult to judge deviations from social norms across different situations and cultures.
What is systematic desensitisation?
behavioural therapy designed to gradually reduce phobic anxiety through classical conditioning (new response to stimulus is learned through counter conditioning)
What are the three processes of systematic desentitisation?
anxiety hierarchy
relaxation
exposure
What is an anxiety hierarchy?
put together by therapist in a systematic desensitisation session in order to list situations phobia from least to most frightening
What is relaxation technique in systematic desensitisation?
impossible to be afraid and relaxed, drugs can be used but also deep breathing and imagining relaxed situation
What is exposure in systematic desensitisation?
finally client is exposed to stimulus, takes place across several sessions when client can stay calm and relaxed they move up the hierarchy and treatment is successful once client stays calm and relaxed at top of hierarchy
What is flooding?
involves exposing people to phobias all at once instead of gradual with immediate exposure. typically longer sessions lasting 2-3 hours
What are the two ways behaviourists treat phobias?
Systematic desensitisation
Flooding
How does flooding work?
exposing client to stimulus in a closed environment where they have no choice to run away or not confront
When does flooding work?
once learned response is extinguished when CS is encountered with UC resulting in CS no longer producing CR (fear)
some achieve relaxation through exhaustion from own fear response
What are the ethical safeguards in flooding?
needs fully informed consent as very traumatic and unpleasant so usually also given option of flooding or systematic desensitisation
How is systematic desensitisation better for those with learning difficulties?
some people requiring treatment for phobias also have learning disabilities. However alternative not suitable as they often struggle with cognitive therapies that require complex rational thoughts
means SD is often most appropriate treatment
What is the evidence of effectiveness for systematic desensitisation?
Gilroy et al (2003) followed up to 42 people who had SD for spider phobia in 3 45 minute sessions. Reviewed at both 3 and 33 months . SD group less fearful than control group treated by relaxation
Means SD is likely to help those with phobias
What is the extra evaluation for systematic desensitisation?
traditional SD involves expose in a real-world setting however are advantages to exposing in VR to avoid dangerous situation and is cost effective as do not need to leave room. but may be less effective as lacks realism
How is flooding cost effective?
cost is a huge issue within the NHS when providing treatment. Flooding can work in one session opposed to SD. This makes it more cost effective as it’s clinically effective and not expensive
means more people can be treated at same cost with flooding than SD
How can flooding be traumatic?
confronting ones phobias stimulus in an extreme form provokes tremendous anxiety. Schumacher et al found p’s and therapists rated flooding as more stressful than SD. Raises the ethical issues of causing stress to clients so have to obtain informed consent. Attrition (drop out rates) higher than in SD
Suggests overall therapists may avoid using this treatment
What is the extra evaluation for flooding?
a limitation is it only masks the symptoms and do not tackle underlying cause. Example: case of woman with fear of death. fear of death declined but fear of a criticism worsened however only evidence for symptom substitution comes from case studies so may only generalise to the phobia in the study
What is failure to function adequately?
person may cross the line between normal and abnormal to point where they cannot cope with everyday demands
When can you tell if someone is failing to function adequately?
Rosenhan and Seligman proposed additional signs to determine if someone isn’t coping:
-person no longer conforms to standard of interpersonal rules (e.g eye contact)
-person experiences server emotional distress
-Persons behaviour becomes irrational or dangerous to themselves or others
What is the example disorder of failing to function adequately?
Intellectual disability disorder (low IQ) which in order to diagnose must be failing to function adequately
How does failure to function adequately represent the threshold for help?
most of us have mental disorders to some degree.. According to mental health charity 25% of people (UK) will experience mental health problems. However many people press on in face of server symptoms. Tend to find help after time and cannot function adequately allowing it to get worse until referral by health care
criteria means that treatment and services can be targeted to those who need it the most
How does discrimination and social control come into failure to function adequately?
In practise it can be hard to say when your either failing to function or just chosen to deviate from social norms. For example: high risk leisure activities such as base jumping may be irrational or dangerous to themselves or others
Means people with unusual choices are at risk of being labelled abnormal and their freedom of choice may be restricted.
What is the extra evaluation for failure to function?
failure to function may not be abnormal. Some circumstances in which most of us fail to cope it may be unfair to give someone label that may cause future problems just because they react to difficult circumstances
On other hand failure to function is no less real just because cause is clear and some need professional help to adjust to circumstances
What is deviation from ideal mental health?
once we have picture of how we should be psychologically healthy can begin to identify deviations.
What was the criteria by Marie Jahoda for the ideal mental health?
-no symptoms of distress
-rational and can perceive oneself accurately
-self actualised
-can cope with stress
-realistic view of world
-good self esteem and lack of guilt
-independent of other people
-successfully work, love and enjoy leisure
How might the criteria for ideal mental health be culturally bound?
some of Jahoda’s criteria are firmly located in context of US and Europe. In particular concept of self actualisation would probably be dismissed as self indulgent in much of world. Even within europe there is quite a lot of variation in values perceived on personal independence. Furthermore what defines success in out working, social and love-lives is very different from one culture to the other
Means it is difficult to apply concept from one culture to another
How does deviation from the ideal mental health concept offer a comprehensive definition?
Jahoda’s concept includes a range of criteria for distinguishing mental health from mental disorders. Covers most of reasons we might seek help with out mental health. Means an individuals mental health can be discussed meaningfully with a range of professionals who may propose a different view.
Means ideal mental health provides checklist against which we can assess ourselves and others and discuss psychological issues with range of professionals
What is the extra evaluation for deviation from ideal mental health as a definition of abnormality?
Extremely high standards
very few of us attain all of criteria for mental health, nor can achieve all at same time or for set period. Can also be disheartening
On other hand having such a comprehensive set of criteria to work towards might be of practical value to someone wanting to understand or improve their mental health
What are the three different types of phobias?
Specific phobia
Social anxiety
Agoraphobia
What is specific phobia?
phobia of an object
What is social anxiety?
phobia of social situations
What is agoraphobia?
phobia of the outside or public spaces
What are the three characteristics of phobias?
emotional, behavioural and cognitive
What are the behavioural characteristics of phobias?
panic
endurance
avoidance
What are the emotional characteristics of phobias?
anxiety
emotional response is unreasonable
fear
What are the cognitive characteristics of phobias?
cognitive distortion (perception of phobia may be inaccurate or unrealistic)
selective attention to phobic stimulus (can be hard to look away from phobic stimulus)
irrational beliefs (may hold unfounded thoughts in relation to phobia)
what is the two process model in behaviourists explanation of phobias?
approach emphasises the acquisition of behaviour, Mowrer proposed a two process model based on this where we acquire phobias by classical conditioning and maintain through operant conditioning
What is acquisition by classical conditioning in phobias?
associating something we have no fear (neutral stimulus) with something which already triggers fear (unconditioned stimulus)
How does the research around Little albert show acquisition by classical conditioning?
Initially Little Albert showed no fear of white rats (neutral stimulus)
What is Ellis’s model to explaining depression?
ABC model
What is Ellis’s ABC model used to propose?
proposed good mental health result of rational thinking so anxiety and depression result of irrational thoughts
How does Ellis define irrational thoughts?
defined irrational thoughts not as illogical or unrealistic but any thought that interferes with us being happy and free from pain
What is the ABC model by Ellis?
A - activating events, thoughts triggered by events
B - beliefs, musturbation (perfectionism), utopianism (life is meant to be fair)
C - consequences, emotional and behavioural consequences
What is Becks explanation for depression?
negative triad
What is Becks negative triad?
Beck suggests a person develops as dysfunctional view of themselves due to three types of negative thinking:
negative view of world
negative view of future
negative view of self
What two things influence depression according to Beck?
Faulty information processing- when depressed people attend to negative aspects pf a situation and ignore positives
Negative self schema- interpreting information about themselves in a negative way
What is the research support for Beck’s negative triad?
‘cognitive vulnerability’ refers to way of thinking than can pre dispose depression. In review Clark and Beck concluded not only was CV more common in depressed people but they proceeded depression confirmed in recent study by Cohen et al where tracked development of 473 adolescence regularly measuring vulnerability. Found vulnerability later predicted depression
shows there is an association between CV and depression
What is the real world application for becks negative triad?
Cohen et al concluded assessing cognitive vulnerability allows psychologists to screen young people identifying those at higher risk also applied to CBT making people more resistant to negative life events
means understanding of cognitive vulnerability useful in more than one aspect of clinical practise
What was the extra evaluation for Beck’s negative triad?
there seems to be no doubt that depressed people show particular patterns of cognition and can be seen before onset of depression. So Becks offers a partial explanation. However there are some aspects to depression which not well explained by cognitive explanations such as feelings of extreme anger, hallucinations or delusions.
What is the cognitive approach to explaining depression?
Becks negative triad
Ellis’s ABC model
How is reactive and endogenous depression a limitation of Ellis’s ABC model?
no doubt depression is triggered by real life events (‘activating events’). Such cases are called reactive depression. How we respond to negative life events also seems to be at least partly result of beliefs. However many cases not traceable to life events and it is not obvious. Sometimes called endogenous depression.
means model can only explain some cases of depression so only partial explanation
What is the real world application for Ellis’s ABC model?
Ellis’s approach to cognitive therapy is called rational emotive behaviour therapy (REBT) . The idea of REBT is that vigorously arguing with depressed person can alter irrational beliefs that are making them unhappy. There is some evidence to support idea that REBT can change both negative beliefs and symptoms of depression.
Means REBT has real world value
What is Ellis’s ABC model extra evaluation?
ABC model is controversial because it locates responsibility for depression on depressed person. But provided it is used appropriately and sensitively application of model in RBT does appear to make depressed people more resilient and feel better
What is the behaviourist explanation of phobias?
two process model which emphasises the learning in the acquisition of behaviour
Who proposed model to show how behaviourists explain phobias?
Mowrer
What does the two process model (of phobias) state?
states that phobias are acquired by classical conditioning and continued by operant
How does acquisition of a phobia happen through classical conditioning?
associating something we have no fear (neutral stimulus) with something which already triggers fear (unconditioned stimulus)
How does the research by Watson and Rayner show acquisition of a phobia by classical conditioning?
Initially Albert showed no fear of white rats with loud and frightening noises (unconditioned stimulus) which naturally caused fear (unconditioned response). After repeated pairing, albert began to fear rat alone, making it a conditioned stimulus that triggered conditioned response (fear). This fear also generalised to similar objects (e.g. Santa’s beard, rabbits)
How does maintenance of a phobia by operant conditioning work?
response from classical usually tend to decline overtime however phobias usually long lasting. Mowrer proposed phobias persistent due to negative reinforcement (by avoiding the object/situation reinforcing avoidance behaviour )
How do links between bad experiences and phobias help the view of behaviourists on explaining phobias?
the little albert study shows how frightening experiences involving stimulus can cause phobia stimulus. Jongh et al found 73% people who had dental fear had a traumatic event. Compared to only 21% who had experienced trauma with low anxiety
this confirms the association between stimulus and response does lead to phobia
What is the counter point to links between bad experiences and phobia in behaviourists explanation for phobias?
not all phobias appear following a bad experience. In fact some phobias such as snakes occur in population where very few have any experience with snakes. Also, considering the other direction, not all frightening experiences lead to phobias
means association between phobia and frightening experiences are not as strong as expected
What is the extra evaluation for behaviourist approach to explaining phobias?
behavioural model phobias such as the two process model provide credible explanations however there are other more general aspects to phobias that may be better explained by evolutionary theory
How does the two process theory proposed by behaviourists for phobias not account for cognitive aspect of phobias?
behavioural explanations, including two process theory, are geared towards explaining behaviour. In case of phobias where key behaviour is avoidance of phobic stimulus. However we know phobias are not just avoidance response - also have significant cognitive component. For example people irrational beliefs about certain phobic stimuluses. SO does not offer explanation for phobic cognition
means that the two-process model does not completely explain the symptoms of phobias
Where is there application in exposure therapy for the behaviourists explanation for phobias?
phobias are maintained by avoidance of phobic stimulus in the two process theory. This is important in explaining why people with phobias benefit from being exposed to phobic stimulus. once avoidance behaviour prevented it ceases to be reinforced by the experience of anxiety reduction and avoidance between declines. In behavioural terms the phobia is the avoidance behaviour
Shows the value of the two process approach because it identifies a means to treating the phobia
What is CBT?
cognitive behavioural therapy
What is the cognitive element of CBT?
begins with assessment to clarify problems, make plans/goals to achieve. One central task is to identify where there may be negative or irrational thoughts
What is the behavioural element of CBT?
working to change negative or irrational thoughts and put more effective behaviours in place
What is behavioural activation?
goal 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) Therapists aim to reinforce activity
How has Becks research been used in the cognitive approach to treat depression?
Cognitive therapy based on his theory depression, which highlights the negative triad. Therapy focuses on identifying and challenging these automatic negative thoughts. A key technique is helping clients to test value of beliefs (such as recording positive experience’s). This approach is sometimes called the ‘client as scientist’ method where clients gather evidence to challenge negative assumptions
How has Ellis’s research been used in the cognitive approach to treat depression?
REBT is an extension of the ABC model adding the D (dispute) and E (effect) to help clients challenge irrational thoughts. Therapists identify irrational beliefs, such as utopianism, and dispute them through logical and empirical arguments,, The goal is to replace irrational beliefs with rational ones, breaking link between negative experiences and emotional distress. Disputing can involve empirical arguments (checking for evidence of negative thought) or logical argument (whether thought follows fact)
How does evidence for effectiveness support CBT?
many studies show CBT works. March et al compared CBT to antidepressants and combination when treating adolescence. After 36 weeks, 81% of both CBT and antidepressants while combination produced 86% in significant improvement. So CBT effective alone as well as combined. CBT also more cost effective as it is fairly brief requiring 6-12 sessions.
means CBT widely seen as first choice of treatment in public and national health care services
How do relapse rates effect the usefulness of CBT?
Although CBT good for tackling symptoms some concern over how long benefits last. Recent studies see long term effectiveness as not good as assumed. Ali et al assessed depression in 439 clients every month for 12 following CBT. 42% of clients relapsed in 6 months, 53% within a year.
Means CBT may need to be repeated periodically
What is the extra evaluation for CBT as cognitive treatment for depression?
CBT for depression focuses on identifying and changing unhelpful thinking patterns and behaviours. Good for short term effectiveness however not all clients want to tackle their depression in this way. Yrondi found CBT least preferred way of treatment as most clients want symptoms gone quickly and easily as possible.
How is CBT not suitable for diverse clients?
In some cases depression so server clients lack motivation for CBT, may not be able to pay attention in session. Also likely the complex rational thinking involved not suitable for those with learning difficulties. Sturmey suggests that in general any form of psychotherapy not suitable for learning difficulties.
Suggests may only be appropriate for specific range of people
What is the counter point for limitation of use of CBT on diverse clients?
recent evidence challenges idea of only suitable for certain cases. Review by Lewis & Lewis concluded CBT was as effective as antidepressants and behavioural therapies for server depression. Another review by Taylor et al concluded CBT is effective for those with learning difficulties when used appropriately.
means CBT may be suitable for wider range of people than once thought
