Psychopathology

Question 1

Definitions of abnormality- Define Statistical infrequency

Answer 1

Occurs when an individual has a less common characteristic, for example being more depressed or less intelligent than most of the population.

Question 2

Definitions of abnomality-Statistical infrequency (Example: IQ and intellectual disability disorder)

Answer 2

This statistical approach comes into its own when we are dealing with characteristics that can be reliably measured, for example intellience. In any human characteristic, the majority of people’s scores will cluster around the average, and that the further we go above or below that average, the fewer people will attain that score. This is called the normal distribution.
The average IQ is set at 100. In a normal distribution, most people (68%) have a score in the range from 85 to 115. Only 2% of people have a score below 70. Those individuals scoring below 70 are very unusual or ‘abnormal’, and are liable to recieve a diagnosis of a psychological disorder-Intellectual disability disorder.

Question 3

Definitions of abnomality-Statistical infrequency (Evaluation: Real-world application)

Answer 3

One strength is its usefulness.
Statistical infrequency is used in clinical practice, both as part of a formal dianosis and as a way to assess the severity of an individual’s symptoms. For example, a diagnosis of intellectual disability disorder requires an IQ of below 70 (bottom 2%). An example of statistical infrequency used in an assessment tool is the Beck depression inventor (BDI). A score of 30+ (top 5% of respondents) is widely interpreted as indicating severe depression. This shows that the value of the statistical infrequency criterion is useful in diagnostic and assessment processes.

Question 4

Definitions of abnomality-Statistical Infrequency: (Evaluation: Unusual characteristics can be positive)

Answer 4

For every person with an IQ below 70 thereis another with an IQ above 130. Yet we would not think of someone as abnormal for having a high IQ. Similarly, wewould not think of someone with a very low depression score on the BDI as abnormal. These examples show that being unusual or at one end of psychological spectrum des not necessarily make someone abnormal.
THis means that, although statistical infrequency can form part of assessment and diagnostic procedures, it is never sufficient as the sole basis fr defining abnormality.

Question 5

Definitions of abnormality- Define Deviation from social norms

Answer 5

Concerns behaviour that is different from the accepted standards of behaviour in a community or society.

Question 6

Definitions of abnomality- Deviation from social norms (Norms are specific to the culture we live in)

Answer 6

Social norms may be different for each generation and different in every clture, so there are relatively few behaviours that would be considered universally abnormal on the basis that they breach social norms. For example, homosexuality was considered abnormal in our culture in the pat and continues to be viewed as abnormal (and illegal) in some cultures.

Question 7

Definitions of abnomality- Deviation from social norms (Example: antisocial personalisty disorder)

Answer 7

a person with anisocial personality disorder is impulsive, aggressive and irresponsible. According to the DSM-5 (the manual used by psychiatrists to diagnore mental disorder) one important symptom of antisocial personality disorder is an ‘absence of prosocial internal standards associated with failure to conform to lawful and culturally normative ethical behaviour’.
In other words, we are makng the social judgement that psychopaths are abnormal because they don’t conform to our moral standards. Psychopathic behaviour would be considered abnormal in a very wide range of cultures.

Question 8

Definitions of abnomality- Deviation from social norms (Evaluation: Real-world application)

Answer 8

One strength is its usefulness.
Deviation from social norms is used in clinical practice. For example, the key defining characteristic of antisocial personality disorder is the failure to conform to culturally acceptable ethical behaviour i.e. recklessness, aggression, violating the rights of others and deceitfulness. These signs of the disorder are all deviations from social norms. Such norms also play a part in the diagnosis of schizoptypal personality disorder, where the term ‘strange’ is usedto characterise the thinking, behaviour and appearance of people with the disorder.
This shows that the deviation from social norms criterion has value in psychiatry.

Question 9

Definitions of abnomality- Deviation from social norms (Evaluation: Cultural and situational relativism)

Answer 9

One limitation ofdeviation from social norms is the variability between social norms in different cultures and even different situations.
A person from one cultural group may label someone from another group as abnormal using their standards rather than the person’s standards. For example, the experience of hearing voices is the norm in some cultures(as messages from ancestors) but would be seen as a sign of abnormality in most partsof the UK. Also, even within one cultural context social norms differ from one situation to another. Aggressive and deceitful behaviour in the context of family life is more socially unacceptable than in the context of corporate deal-making.
This means that it is difficult to judge deviation from social norms across different situations and cultures.

Question 10

Definitions of abnormality-Define Failure to function adequately

Answer 10

Occurs when someone is unable to cope with ordinary demands of day-to-day living.

Question 11

Definitions of abnormality-Failure to function adequately: (When is someone failing to function adequately)

Answer 11

Rosenhan and Seligman (1989) have proposed some additional signs that can be used to determine when someone is not coping. These include:

• When a person no longer conforms to standard interpersonal rules, for example maintaining eye contact and respecting personal space.

-When a person experiences severe personal distress

-When a person’s behaviour becomes irrational or dangerous to themselves or others.

Question 12

Definitions of abnormality-Failure to function adequately: (Example: intellectual disability disorder)

Answer 12

A diagnosis would not be made on this basis only- an individual must also be failing to function adequately before a diagnosis would be given.

Question 13

Definitions of abnormality-Failure to function adequately: (Evaluation: Represents a threshold for help)

Answer 13

It represents a sensible threshold for when people need professional.
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 in any given year. However, many people press on it 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.

Question 14

Definitions of abnormality-Failure to function adequately: (Evaluation: Discrimination and social control)

Answer 14

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. For example, 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.

Question 15

Definitions of abnormality- Define Deviation from ideal mental health

Answer 15

Occurs when someone does not not meet a set of criteria for good mental health.

Question 16

Definitions of abnormality: Deviation from ideal mental health: (What does ideal mental health look like?)

Answer 16

Jahoda (1958) suggested that we are in good mental health if we meet the following criteria:

• we have no symptoms or distress
• we have good self-esteem and lack guilt
• we are independent of other people

There is some overlap between what we might call deviation from ideal mental health and what we might call failure to function adequately. So we can think of someone’s inability to keep a job as either a failure to cope with the pressures of work or as a deviation from the ideal of successfully working.

Question 17

Definitions of abnormality: Deviation from ideal mental health: (Evaluation: A comprehensive definition)

Answer 17

Jahoda’s concept of ‘ideal mental health’ includes a range of criteria for distinguishing mental health from mental disorder. In fact it covers most of the reasons why we might seek (or be referred for) help with mental health. This in turn means that an individual’s mental health can be discussed meaningfully with a range of professionals who might take different theoretical views e.g. a medically-trained psychiatrist might focus on symptoms whereas a humanistic counsellor might be more interested in self-actualisation.
This means that ideal mental health provides a checklist against which we can assess ourselves and others and discuss psychological issues with a range of professionals.

Question 18

Definitions of abnormality: Deviation from ideal mental health: (Evaluation: May be culture-bound)

Answer 18

One limitation is that its different elements are not equally applicable across a range of cultures.
Some of Jahoda’s criteria for ideal mental health are firmly located in the extent of the US and Europe generally. In particular the concept of self-actualisation would probably be dismissed as self-indulgent in much of the world. Even within Europe there is quite a bit of variation in the value placed on personal independence, e.g. high in Germany, low in Italy. Furthermore what defines success in our working, social and love-lives is very different in different cultures.
This means that it is difficult to apply the concept of ideal mental health from one culture to another.

Question 19

Phobias: Define Phobia

Answer 19

An irrational fear of an object or situation.

Question 20

Phobias: Define Behavioural

Answer 20

Ways in which people act.

Question 21

Phobias: Define Emotional

Answer 21

Related to a person’s feelings or mood.

Question 22

Phobias: Define cognitive

Answer 22

Refers to the process of ‘knowing’, including thinking, reasoning, remembering and believing.

Question 23

Phobias- Behavioural characteristics of phobias: Panic

Answer 23

A person with a phobia may panic in response to the presence of the phobic stimulus. Panic may involve a range of behaviours including crying, screaming or running away. Children may react slightly differently, for example by freezing, clinging or having a tantrum.

Question 24

Phobias- Behavioural characteristics of phobias: Avoidance

Answer 24

Unless the person is making a conscious effort to face their fear they tend to go to a lot of effort to prevent coming into contact with the phobic stimulus. This can make it hard to go about daily life.
For example, someone with a fear of public toilets may have to limit the time they sped outside the home in relation to how long they can last without a toilet. This in turn can interfere with work, education and a social life.

Question 25

Phobias- Behavioural characteristics of phobias: Endurance

Answer 25

The alternative behavioural response to avoidance is endurance. This occurs when the person chooses to remain in the presence of the phobic stimulus. For example, a person with arachnophobia choose to remain in a room with a spider in the ceiling and keep a wary eye on it rather than leaving.

Question 26

Phobias- Emotional characteristics of phobias: Anxiety

Answer 26

Phobias are classed as anxiety disorders. By definition then they involve an emotional response of anxiety, an unpleasant state of high arousal. This prevents a person relaxing and makes it very difficult to experience any positive emotion. Anxiety can be long term.

Question 27

Phobias- Emotional characteristics of phobias: Fear

Answer 27

Although in everyday speech we might use the terms ‘anxiety’ and ‘fear’ interchangeably they do have distinct meanings. Fear is the immediate and extremely unpleasant response we experience when we encounter or think about a phobic stimulus. It is usually more intense but experienced for shorter periods than anxiety.

Question 28

Phobias- Emotional characteristics of phobias: Emotional response is unreasonable

Answer 28

The anxiety or fear is much greater than is ‘normal’ and disproportionate to any threat posed. For example, a person with arachnophobia will have a strong emotional response to a tiny spider. Most people would respond in a less anxious way even to a poisonous spider.

Question 29

Phobias- Cognitive characteristics of phobias: Selective attention to the phobic stimulus.

Answer 29

If a person can see the phobic stimulus it is hard to look away from it. 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.

Question 30

Phobias- Cognitive characteristics of phobias: Irrational beliefs

Answer 30

A person with a phobia may hold unfounded thoughts in relation to phobic stimuli, i.e. that can’t be easily explained and don’t have any basis in reality. For example, social phobias can involve beliefs like ‘I must always sound intelligent’ or ‘if
I blush people will think I’m weak.’ This kind of belief increases the pressure on the person to perform well in social situations.

Question 31

Phobias- Cognitive characteristics of phobias: Cognitive distortions

Answer 31

The perceptions of a person with a phobia may be inaccurate and unrealistic. So, for example, someone with mycophobia sees mushrooms as disgusting.

Question 32

Depression: Define Depression

Answer 32

A mental disorder characterised by low mood and low energy levels.

Question 33

Depression: Behavioural characteristics of depression: Activity levels

Answer 33

Typically people with depression have reduced levels of energy, making them lethargic. This has a knock-on effect, with people tending to withdraw from work, education and social life. In extreme cases this can be so severe that the person 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.

Question 34

Depression: Behavioural characteristics of depression: Disruption to sleep and eating behaviour

Answer 34

Depression is associated with changes to sleeping behaviour. A person may experience reduced sleep (insomnia), particularly premature waking, or an increased need for sleep (hypersomnia). Similarly, appetite and eating may increase or decrease, leading to weight gain or loss. The key point is that such behaviours are disrupted by depression.

Question 35

Depression: Behavioural characteristics of depression: Aggression and self-harm

Answer 35

People with depression are often irritable, and in some cases they can become verbally or physically aggressive. This can have some serious knock-on effects on a number of aspects of their life. For example, someone experiencing depression might display verbal aggression by ending a relationship or quitting a job.
Depression can also lead to physical aggression directed against the self. This includes self-harm, often in the form of cutting, or suicide attempts.

Question 36

Depression: Emotional characteristics of depression: Lowered mood

Answer 36

When we use the word ‘depressed’ in everyday life we are usually describing having a lowered mood, in other words feeling sad. As you can see from the rest of this spread there is more to clinical depression than this.
Lowered mood is still a defining emotional element of depression but it is more pronounced than in the daily kind of experience of feeling lethargic and sad. People with depression often describe themselves as ‘worthless’ and ‘empty’.

Question 37

Depression: Emotional characteristics of depression: Anger

Answer 37

Although people with depression tend to experience more negative emotions and fewer positive ones during episodes of depression, this experience of negative emotion is not limited to sadness. People with depression also frequently experience anger, sometimes extreme anger. This can be directed at the self or others. On occasion such emotions lead to aggressive or self-harming behaviour- which is why characteristic appears under behavioural characteristics as well.

Question 38

Depression: Emotional characteristics of depression: Lowered self-esteem

Answer 38

Self-esteem is the emotional experience of how much we like ourselves. People with depression tend to report reduced self-esteem, in other words they like themselves less than usual. This can be quite extreme, with some people with depression describing a sense of self-loathing i.e. hating themselves.

Question 39

Depression: Cognitive characteristics of depression: Poor concentration

Answer 39

Depression is associated with poor levels of concentration. The person may find themselves unable to stick with a task as they usually would, or they might find it hard to make decisions that they would normally find straightforward. Poor concentration and poor decision-making are likely to interfere with the individual’s work.

Question 40

Depression: Cognitive characteristics of depression: Attending to and dwelling on the negative

Answer 40

When experiencing a depressive episode people are inclined to pay more attention to negative aspects of a situation and ignore the positives. In other words they tend to see a glass as half-empty rather than half-full.
People with depression also have a bias towards recalling unhappy events rather than happy ones- the opposite bias that most people have when not depressed.

Question 41

Depression: Cognitive characteristics of depression: Absolutist thinking

Answer 41

Most situations are not all-good or all-bad, but when a person is depressed they tend to think in these terms. This is sometimes called ‘black-and-white thinking’. This means that when a situation is unfortunate they tend to see it as an absolute disaster.

Question 42

Obsessive-Compulsive disorder (OCD): Define OCD

Answer 42

A condition characterised by obsessions and/or compulsive behaviour. Obsessions are cognitive whereas compulsions are behavioural.

Question 43

Obsessive-Compulsive disorder (OCD)- Behavioural characteristics of OCD: Compulsions are repetitive

Answer 43

Tpically people with OCD feel compelled to retreat a behaviour. A common example is handwashing. Other common compulsive repetitions include counting, praying and tidying/ordering groups of objects such as CD collections or containers in a food cupboard.

Question 44

Obsessive-Compulsive disorder (OCD)- Behavioural characteristics of OCD: Compulsions reduce anxiety

Answer 44

Around 10% of people with OCD show compulsive behaviour alone- they have no obsessions, just a general sense of irrational anxiety. However, for the vast majority, compulsive behaviours are performed in an attempt to manage the anxiety producd by obsessions. For example, compulsive handwashing is carried out as a response to an obsessive fear of germs. compulsive checking, for example that a door is locked or a gas appliance is switched off, is in response to the obsessive thought that it might have been left unsecured.

Question 45

Obsessive-Compulsive disorder (OCD)- Behavioural characteristics of OCD: Avoidance

Answer 45

The behaviour of people with OCD may also be characterised ny their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger it.
People with OCD tend to try to manage their OCD by avoiding situations that trigger anxiety. For example, people who wash compulsively may avoid coming into contact with germs. However, this avoidance can lead people to avoid very ordinary situations, uch as emtpying their rubbish bins, and this can in itself interfere with leading a regular life.

Question 46

Obsessive-Compulsive disorder (OCD)- Emotional characteristics of OCD: Anxiety and distress

Answer 46

OCD is regarded as a particularly unpleasant emotionalexperience because of the powerful anxiety that accompanies both obsessions and compulsions. 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.

Question 47

Obsessive-Compulsive disorder (OCD)- Emotional characteristics of OCD: Accompanying depression

Answer 47

OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities. Compulsive behaviour tends to bring some relief from anxiety but this is temporary.

Question 48

Obsessive-Compulsive disorder (OCD)- Emotional characteristics of OCD: Guilt and disgust

Answer 48

As well as anxiety and depression, OCD sometimes involves other negative emotions such as irrational guilt, for example over minor moral issues, or disgust, which may be directed against something external like dirt or at the self.

Question 49

Obsessive-Compulsive disorder (OCD)- Cognitive characteristics of OCD: Obsessive thoughts

Answer 49

For around 90% of people with OCD the major cognitive feature of their condition is obsessive thoughts, i.e. thoughts that recur over and over again. These vary considerably from one person to person but are always unpleasant. Examples of reccuring thoughts are worries of being contaminated by dirst and germs, or a door being unlocked.

Question 50

Obsessive-Compulsive disorder (OCD)- Cognitive characteristics of OCD: Cognitive coping strategies

Answer 50

Obsessions are the major aspect of OCD, but people also respond by adopting cognitive coping strategies to deal with the obsessions. for example, a religious person tormented by obsessive guilt may respond by praying or meditating. This may help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks.

Question 51

Obsessive-Compulsive disorder (OCD)- Cognitive characteristics of OCD: Insight into excessive anxiey

Answer 51

People with OCD are aware that their obsessions and compulsions are notrational. In fact this is necessary for a diagnosis of OCD. If someone really beleved their obsesssive thoughts were based on reality that would be a smptom of a quite different form of mental disorder. However, in spiteof this insight, people with OCD experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified. They also trend to be hypervigilant, i.e. they maintain constant alertness and keep attention focused on potential hazards.

Question 52

The behavioural approach to explaining phobias: Define Behavioural (behaviourist) approach

Answer 52

A way of explaining behaviour in terms of what is observable and in terms of learning.

Question 53

The behavioural approach to explaining phobias: Define two-proccess model

Answer 53

An exxplanation for the onset and persistance of disorders that create anxiety, such as phobias. The two processes are classical conditioning for onset and operant conditioning for persistence.

Question 54

The behavioural approach to explaining phobias: Define Classical conditioning

Answer 54

Learning by association. Occurs when teo stimuli are repeatedly paired together- an unconditioned (unlearned) stimulus (UCS) and a new ‘neutral’ stimulus (NS). The neutral stimulus eventually produces the same response that was first produced by the unconditioned (unlearned) stimulus alone.

Question 55

The behavioural approach to explaining phobias: Define Operant conditioning

Answer 55

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.

Question 56

The behavioural approach to explaining phobias-The two-process model

Answer 56

Mowrer (1960) proposed the two-process model based on the behavioural approach to phobias. This states that phobias are acquired (learned in the first place) by classical conditioning and then continue because of operant conditioning.

Question 57

The behavioural approach to explaining phobias- The two process model: Acquisition by classical conditioning

Answer 57

Classical conditioning involves learning to associate something of which we initially have no fear (called a neutral stimulus) with something that already triggers a fear response (known as a unconditioned stimulus).

Watson and Rayner (1920) created a phobia in a 9-month old baby called ‘Little Albert’. Albert showed no unusual anxiety at the start of the study. When shown a white rat he tried to play with it. However, the experimenters then set out to give Albert a phobia. Whenever the rat was presented to Albert the researchers made 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. When the rat ( a neutral stimulus) and the UCS are encountered close together in time the NS becomes associated with the UCS and both now produce the fear response- Albert displayed fear when he saw a rat (NS). The rat is now a learned or a conditioned stimulus (CS) that produces a conditional 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.

Question 58

The behavioural approach to explaining phobias- The two-process model: Maintenance by operant conditioning

Answer 58

Responses acquired by classical conditioning usually tend to decline over time. However, phobias are often long-lasting. Mowrer has explained this as the result of operant conditioning.
Operant conditioning takes place when our behaviour is reinforced (rewarded) or punished. Reinforcement tends to increase the frequency of a behaviour, This is true of both negative reinforcement and positive reinforcement. In the case of negative reinforcement an individual avoids a situation that is unpleasant.
Mowrer 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.

Question 59

The behavioural approach to explaining phobias- The two-process model:(Evaluation: Phobias and traumatic experiences)

Answer 59

A strength 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 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.

Question 60

The behavioural approach to explaining phobias- The two-process model: (Evaluation: Counterpoint for Phobias and traumatic experiences)

Answer 60

Not all phobias appear following a bad experience. In fact some common phobias such as snakes phobias occur in populations where very few people have any experiences 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.

Question 61

The behavioural approach to explaining phobias- The two-process model: (Evaluation: Cognitive aspects of phobias)

Answer 61

One limitation 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.

Question 62

The behavioural approach for treating phobias: Define systematic desensitisation (SD)

Answer 62

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.

Question 63

The behavioural approach for treating phobias: Define Flooding

Answer 63

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.

Question 64

The behavioural approach for treating phobias- Systematic desensitisation: info

Answer 64

DS is a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning. If a person can learn to relax in the presence of the phobic stimulus they will be cured.
Essentially a new response to the phobic stimulus is learned (Phobic stimulus is pared with relaxation instead of anxiety). This learning of a different response is called counterconditioning.

Question 65

The behavioural approach for treating phobias- Systematic desensitisation: (1) The anxiety hierarchy

Answer 65

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, for example, a person with arachnophobia might identify a picture of a small spider as low on their anxiety hierarchy and holding a tarantula at the top of the hierarchy.

Question 66

The behavioural approach for treating phobias- Systematic desensitisation: (2) Relaxation

Answer 66

The therapist teaches the client to relax as deeply as possible. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is called reciprocal inhibition. The relaxation might involve breathing exercises or, alternatively, the client might learn mental imagery techniques. Clients can be taught to imagine themselves in relaxing situations (such as imagining lying on a beach) or they might learn meditation. Alternatively relaxation can be achieved using drugs such as Valium.

Question 67

The behavioural approach for treating phobias- Systematic desensitisation: (3) Exposure

Answer 67

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. When the client can stay relaxed in the presence of the lower levels of the phobic stimulus they move up the hierarchy. Treatment is successful when the client can stay relaxed in situations on the anxiety hierarchy.

Question 68

The behavioural approach for treating phobias- Systematic desensitisation: (Evaluation- People with learning disabilities)

Answer 68

A 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.

Question 69

The behavioural approach for treating phobias- Systematic desensitisation: (Evaluation:

Answer 69

One limitation of systematic desensitization is that it may not be effective for all types of phobias. For example, it tends to work better for simple, specific phobias (like fear of spiders or heights) but may be less effective for complex phobias, such as social phobia or agoraphobia. These phobias often involve more intricate underlying issues, such as negative thought patterns or environmental stressors, which may not be addressed by the process of gradually exposing the person to their fear. Therefore, systematic desensitization might need to be combined with other therapeutic approaches, such as cognitive therapy, to be more effective for certain individuals.

Question 70

The behavioural approach for treating phobias- Flooding: How does flooding work?

Answer 70

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).
In some cases, the client may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own fear response.

Question 71

The behavioural approach for treating phobias- Flooding: Ethical safeguards

Answer 71

Flooding is not unethical per se but it is an unpleasant experience so it is important that clients give fully informed consent to this traumatic procedure and that they are fully prepared before the flooding session. A client would normally be given the choice of systematic desensitisation or flooding.

Question 72

The behavioural approach for treating phobias- Flooding: (Evaluation: Cost-effective)

Answer 72

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 which 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.

Question 73

The behavioural approach for treating phobias- Flooding: (Evaluation: Traumatic)

Answer 73

One limitation 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, therapies may avoid using this treatment.

Question 74

The cognitive approach to explaining depression: Define Cognitive approach

Answer 74

The term ‘cognitive’ has come to mean ‘mental processes’, so this approach is focused on how our mental processes (e.g. thoughts, perceptions, attention) affect behaviour.

Question 75

The cognitive approach to explaining depression: Define Negative triad

Answer 75

Beck proposed that there are three kinds of negative thinking that contribute to becoming depressed: negative views of the world, the future and self. Such negative views lead a person to interpret their experiences in a negative way and so make them more vulnerable to depression.

Question 76

The cognitive approach to explaining depression: Define ABC model

Answer 76

Ellis proposed that depression occurs when an activating event (A) triggers an irrational belief (B) which in turn produces a consequence (C).

Question 77

The cognitive approach to explaining depression- Beck’s negative triad: (1) Faulty information processing

Answer 77

This is when depressed people attend to the negative aspects of a situation and ignore the positives. For example, if I was depressed and won £1 million, I might focus on the fact that the previous week someone had won £10 million, rather than focus on the positive of all I could do with £1 million. Depressed people may tend to towards ‘black and white thinking’ where something is either all bad or all good.

Question 78

The cognitive approach to explaining depression- Beck’s negative triad: (2) Negative Self-schema

Answer 78

A 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.

Question 79

The cognitive approach to explaining depression- Beck’s negative triad: (3) The negative triad

Answer 79

a) Negative view of the world- an example would be ‘the world is 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.

Question 80

The cognitive approach to explaining depression- Beck’s negative triad: (Evaluation: Research support)

Answer 80

‘Cognitive vulnerability’ refers to the 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 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.

Question 81

The cognitive approach to explaining depression- Beck’s negative triad: (Evaluation:

Answer 81

One limitation of Beck’s negative triad is that it may be too simplistic in explaining the complexity of depression. While the triad focuses on negative thoughts about the self, the world, and the future, it does not fully account for the biological or environmental factors that can contribute to depression. For example, research has shown that genetic factors, neurotransmitter imbalances, and stressful life events also play significant roles in the development of depression. This suggests that Beck’s model may overlook the interaction between cognitive, biological, and environmental influences, making it less comprehensive in explaining the causes of depression.

Question 82

The cognitive approach to explaining depression- Ellis’s ABC model: info

Answer 82

Ellis (1962) suggested a different cognitive explanation of depression. He proposed that good mental health is the result of rational thinking, defined as thinking in ways that allow people to be happy and free from pain.
To Ellis, conditions like anxiety and depression (poor mental health) result from irrational thoughts. Elli defined irrational thoughts, not as illogical or unrealistic thoughts, but as any thoughts that interfere with us being happy and free from pain.
Ellis used the ABC model to explain how irrational thoughts affect our behaviour and emotional state.

Question 83

The cognitive approach to explaining depression- Ellis’s ABC model: info 2

Answer 83

A- Activating event:
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.

B- 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.

C- Consequences:
When activating event triggers irrational beliefs there re emotional and behavioural consequences. For example, if a person believes that they must always succeed and then fails at something this can trigger depression.

Question 84

The cognitive approach to explaining depression- Ellis’s ABC model: (Evaluation: Real-world application)

Answer 84

One strength 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 in 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 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 had real-world value.

Question 85

The cognitive approach to explaining depression- Ellis’s ABC model: (Evaluation: Reactive and endogenous depression)

Answer 85

One limitation 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. Ellis’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.

Question 86

The cognitive approach to treating depression: Define Cognitive behaviour therapy (CBT)

Answer 86

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.

Question 87

The cognitive approach to treating depression: Define Irrational thoughts

Answer 87

Thoughts that are likely to interfere with a person’s happiness.

Question 88

The cognitive approach to treating depression- Cognitive behaviour therapy (CBT) info

Answer 88

Cognitive element- CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the client’s problems. They jointly identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.

Behaviour element- CBT then involves working to change negative and irrational thoughts and finally put more effective behaviours into place.

Question 89

The cognitive approach to treating depression- Beck’s cognitive therapy

Answer 89

Beck’s cognitive therapy focuses on identifying and challenging the negative triad- automatic negative thoughts about the self, world, and future. Clients are encouraged to test the reality of these thoughts by recording positive experiences, such as when they enjoyed an event or when someone was nice to them. This is called the “client as scientist” approach. If clients later claim that no one is kind or there’s no point in activities, therapists use these records as evidence to disprove such beliefs.

Question 90

The cognitive approach to treating depression-Ellis’s rational emotive behaviour therapy

Answer 90

Ellis’s Rational Emotive Behaviour Therapy (REBT) expands the ABC model with D for dispute for dispute and E for effect. REBT help clients identify and challenge irrational beliefs, such as blaming bad luck for negative events. Therapists dispute these beliefs using empirical arguments (checking evidence) or logical arguments (testing if beliefs follow facts). The goal is to break the link between irrational beliefs and depression, promoting more rational thinking.

Question 91

The cognitive approach to treating depression: (Evaluation: Suitability for diverse clients)

Answer 91

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. 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.

Question 92

The cognitive approach to treating depression: (Evaluation: Counterpoint for suitability for diverse clients)

Answer 92

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 Lewis and Lewis (2016) concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression. Another review by 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.

Question 93

The cognitive approach to treating depression: (Evaluation Relapse rates

Answer 93

A 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, 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 6 months of ending treatment and 53% relapsed within a year.
This means that CBT may need to be repeated periodically.

Question 94

The biological approach to explaining OCD: Define Biological approach

Answer 94

A perspective that emphasises the importance of physical processes in the body such as genetic inheritance and neural function.

Question 95

The biological approach to explaining OCD: Define Genetic explanations

Answer 95

Genes make up chromosomes and consist of DNA which codes the physical features of an organism (such as eye colour, height) and psychological features (such as mental disorder, intelligence). Genes are transmitted from parents to offspring i.e. inherited.

Question 96

The biological approach to explaining OCD: Define Neural explanations

Answer 96

The view that physical and psychological characteristics are determined by the behaviour of the nervous system, in particular the brain as well as individual neurons.

Question 97

The biological approach to explaining OCD- Genetic explanations: Candidate genes

Answer 97

Researchers identified genes, which create vulnerability for OCD, called candidate genes. Some of these genes are involved in regulating the development of the serotonin system. For example, the gene 5HT1-D beta is implicated in the transport of serotonin across synapses.

Question 98

The biological approach to explaining OCD- Genetic explanations: OCD is polygenic

Answer 98

However, like many conditions, OCD seems to be polygenic. This means that OCD is not caused by one single gene but by a combination of genetic variations that together significantly increase vulnerability.
Taylor (2013) has analysed findings of previous studies and found evidence that up to 230 different genes may be involved in OCD. Genes that have been studied in relation to OCD include those associated with the action of dopamine as well as serotonin, both neurotransmitters believed to have a role in regulating mood.

Question 99

The biological approach to explaining OCD- Genetic explanations: Different types of OCD

Answer 99

One group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person. The term used to describe this is aetiologically heterogeneous, meaning that the origins of OCD vary from one person to another.
There is also some evidence to suggest that different types of OCD may be the result of particular genetic variations, such as hoarding disorder and religious obsession.

Question 100

The biological approach to explaining OCD- Biological explanations: (Evaluation: Research support)

Answer 100

There is evidence from a variety of sources which strongly suggests that some people are vulnerable to OCD as a result of their genetic make-up. One source of evidence is twin studies. In one study Nestadt et al. (2010) reviewed twin studies and found that 68% of identical twins (MZ) shred OCD as opposed to 31% of non-identical (DZ) twins. Another source of evidence for a genetic influence on OCD is family studies. Research has found that a person with a family member diagnosed with OCD is around 4 times as likely to develop it as someone without (Marini and Stebnicki 2012).
These research studies suggest that there must be some genetic influence on the development of OCD.

Question 101

The biological approach to explaining OCD- Biological explanations: (Evaluation: Environmental risk factors)

Answer 101

One limitation of the genetic model of OCD is that there are also environmental risk factors.
There is strong evidence for the idea that genetic variation can make a person more or less valuable to OCD. However, OCD does not appear to be entirely genetic in origin and it seems that environmental risk factors can also trigger or increase the risk of developing OCD. In one study for example, Cromer et al.( 2007) found that over half the OCD clients in their sample had experienced a traumatic event in their past. OCD was also more severe in those with one or more traumas.
This means that genetic vulnerability only provides a partial explanation for OCD.

Question 102

The biological approach to explaining OCD- Neural explanations: The role of serotonin

Answer 102

One explanation for OCD concerns the role of the neurotransmitter serotonin, which is believed to help regulate 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 a person may experience low moods. At least some cases of OCD may be explained by a reduction in the functioning of the serotonin system.

Question 103

The biological approach to explaining OCD- Neural explanations: Decision-making systems

Answer 103

Some cases of OCD, and in particular hoarding disorder, seem to be associated with impaired decision-making. This is turn may be associated with abnormal functioning of the lateral of the frontal lobes of the brain. The frontal lobes are the front part of the brain (behind your head) that are responsible for logical thinking and making decisions.
There is also evidence to suggest that an area called the left parahippocampal gyrus. associated with processing unpleasant emotions, functions abnormally in OCD.

Question 104

The biological approach to explaining OCD- Neural explanations: (Evaluation: Research support)

Answer 104

One strength is the existence of some supporting evidence.
Antidepressants that work purely on serotonin are effective in reducing OCD symptoms and this suggests that serotonin may be involved in OCD. Also, OCD symptoms form part of conditions that are known to be biological in origin, such as the degenerative brain disorder Parkinson’s disease, which causes muscle tremors and paralysis (Nestadt et al. 2010). If a biological disorder produces OCD symptoms, then we may assume the biological processes underlie OCD.
This suggests that biological factors (e.g. serotonin and the processes underlying certain disorders) may also be responsible for OCD.

Question 105

The biological approach to explaining OCD- Neural explanations: (Evaluations: No unique neural system)

Answer 105

One limitation of the neural model is that the serotonin-OCD link may not be unique to OCD.
Many people with OCD also experience clinical depression. Having 2 disorders together called co-morbidity. This depression probably involves disruption to the action of serotonin. This leaves us with a logical problem when it comes to serotonin as a possible basis for OCD. 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 106

The biological approach to treating OCD: Define Drug therapy

Answer 106

Treatment involving drugs, i.e. chemicals that have a particular effect on the functioning of the brain or some other body system.

Question 107

The biological approach to treating OCD- Drug therapy: SSRIs info

Answer 107

The standard medical treatment used to tackle the symptoms of OCD involves a particular type of antidepressant drug called a selective serotonin reuptake inhibitor (SSRI). SSRI’s work on the serotonin system 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 a 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.

By preventing the reabsorption and breakdown, SSRI’s 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.

Dosage and other advice vary according to which SSRI is prescribed. A typical daily dose of fluoxetine is 20 mg although this may be increased if it is not benefitting the person. The drug is available as capsules or liquid. It takes 3 to 4 months of daily use for SSRIs to have much impact on symptoms.

Question 108

The biological approach to treating OCD- Drug therapy: Combining SSRI’s with other treatments

Answer 108

Drugs are often used alongside cognitive behaviour therapy (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.
In practice, some people respond best to CBT alone whilst others benefit more when additionally using drugs like fluoxetine. Occasionally other drugs are prescribed alongside SSRIs.

Question 109

The biological approach to treating OCD- Drug therapy: Alternatives to SSRIs

Answer 109

Where an SSRI is not effective after 3 to 4 months the dose can be increased or it can be combined with other drugs. Sometimes different antidepressants are tired. People respond very differently to different drugs and alternatives work well for some people and not at all for others.

• Tricycles (an older type of antidepressant) are sometimes used, such as clomipramine. 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.

-SNRIs (serotonin-noradrenaline reuptake inhibitors) have more recently been used to treat OCD. 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.
SSRIs increase levels of serotonin as well as another different neurotransmitter-noradrenaline.

Question 110

The biological approach to treating OCD- Drug therapy: (Evaluation: Evidence of effectiveness)

Answer 110

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 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 that drugs appear to be helpful for most people with OCD.

Question 111

The biological approach to treating OCD- Drug therapy: (Evaluation: Counterpoint for Evidence of effectiveness)

Answer 111

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.

Question 112

The biological approach to treating OCD- Drug therapy: (Evaluation: Serious side-effects)

Answer 112

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 problems such as 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.