Psychopathology Flashcards
What is statistical infrequency?
This occurs when an individual has a less common characteristic. Therefore something is classed as abnormal based on how much we come across it. Any relatively usual behaviour or characteristic is normal.
What is an example of statistical infrequency?
Intelligence
With human characteristics the majority of peoples scores cluster around the average, with fewer people above or below that (normal distribution)
The average IQ is 100 and normally 68% of people score between 85-115. Only 2% of people have a score below 70 and those people are deemed as abnormal and could be diagnosed with intellectual disability disorder.
What is a strength of statistical infrequency?
P - One strength of statistical infrequency is its usefulness.
E - Statistical infrequency is used in clinical practice, as it can be used for formal diagnosis and to access the severity of an individual’s symptoms.
E - For example to be diagnosed with IDD it requires an IQ score of below 70. Statistical infrequency is also used in an assessment tool in Beck’s Depression Inventory. In this a score of 30+ which is seen in the top 5% of respondents is seen as severe depression.
L - This shows the value of statistical infrequency in diagnosis.
What is a limitation of statistical infrequency?
P - One limitation of statistical infrequency is that infrequent characteristics can be positive as well as negative.
E - This is because for every person with an IQ below 70 there is one above 130. However the person with the IQ above 130 isn’t seen as abnormal. Likewise someone with a low score on the BDI isn’t seen as abnormal. This shows how being unusual or at one end of the spectrum doesn’t make someone abnormal.
L - Therefore, statistical infrequency can form part of an assessment and diagnostic procedure but isn’t sufficient as the sole basis to define abnormality.
What is another limitation of statistical infrequency?
P - One limitation of statistical infrequency is that there are more problems than benefits.
E - This is because some people who are statistically unusual don’t benefit from labels. For example, someone with a low IQ who can cope with everyday life wouldn’t benefit from a label but would receive the negative stigma attached to a label.
E - However, it could benefit some people with a low IQ to be given a label as they can be given support services from IDD
L - Therefore, it could be negative due to the stigma behind particular labels, however it could also benefit some people.
What is deviation from social norms?
Behaviour which is different from the accepted standard of behaviour in a community or society. Groups of people define behaviour as abnormal based on what they deem acceptable.
How are norms set?
Norms are specific to the culture which we live in and can vary across generations and cultures. However, some behaviours are seen as universally abnormal.
For example homosexuality.
What is an example of deviation from social norms?
Antisocial personality disorder is when a person is impulsive, aggressive and irresponsible.
According to the DSM-5 one important symptom of APD is an ‘absence of prosocial internal standards associated with failure to conform to lawful and culturally normative ethical behaviour’
What is a strength of deviation from social norms?
P - One advantage of deviation from social norms is that it is useful.
E - This is because it is used in clinical practice. For example, the key defining characteristic of antisocial personality disorder is failure to conform to culturally acceptable ethical behaviour. This would be shown in behaviours such as recklessness, aggression and violating others rights.
E - Deviation from social norms play a part in diagnosing other disorders such as schizoptypal personality disorder, where strange is used to characterise the thinking, personality and appearance of those with the disorder.
L - This shows that deviation from social norms has value in psychiatry.
What is a limitation of deviation from social norms?
P - One limitation of deviation from social norms is the variation between social norms in different cultures and even in different situations.
E - This is because a person from one cultural group could label someone from another group as abnormal using their standards instead of the individuals standards.
For example, in some cultures hearing voices is normal and is seen as messages from ancestors whereas in other cultures it is seen as abnormal.
E - Aggressive and deceitful behaviour in the context of family life is socially unacceptable than in the context of corporate deal making.
L - This means it is difficult to judge deviations of social norms across cultures.
What is another limitation of deviation of social norms?
P - One limitation of deviation from social norms is that it could lead to abuse of human rights.
E - This is because deviation from social norms can lead to unfair labelling which would cause abuse. For example, historically women with excessive sexual desires where diagnosed with nymphomania which was used for the unfair controlling of women.
L - This means deviation from social norms may not always be beneficial as a definition of abnormality.
What is failure to function adequately?
This occurs when someone is unable to cope with the ordinary demands of everyday life. This could include being unable to maintain basic standards of nutrition and hygiene or cannot hold down a job or maintain relationships.
When is someone failing to function adequately?
Rosenhan and Seligman have proposed additional signs that can be used to determine when someone isn’t coping. These could include when:
Maladaptive Behaviour - a persons behaviour becomes irrational or dangerous to themselves or others.
Violation of moral standards - a person can no longer conform to standard interpersonal rules, this could include maintaining eye contact and respecting personal space.
Personal Distress - a person experiences severe personal distress
Unconventionality - a person stands out amongst others
Irrationality - a person acts in an unreasonable way
Observer Discomfort
Unpredictability
What is an example of failure to function adequately?
Intellectual Disability Disorder
- This is because one criteria for the diagnosis is a low IQ but it would also have to be made on the basis that a person cannot function adequately for a diagnosis to be given.
What is the advantage of failure to function adequately?
P - One strength of the failure to function is that it represents a sensible threshold for when people need professional help.
E - Most people have symptoms of mental disorders at a point in time. According to the mental health charity Mind, around 25% of people in the UK will experience a mental health problem at a point in time.
E - However, many people press on in the face of fairly severe symptoms, it is at the point where we cease to function adequately where people seek professional help.
L - This means that treatment and services can be targeted to those who need the services the most.
What is a limitation of failure to function adequately?
P - One limitation of failure to function adequately is that it’s easy to label non-standard lifestyle choices as abnormal.
E - This means it can be very hard to tell if someone is failing to function or if they are choosing to live a lifestyle which deviates from social norms.
For example, not living in a permanent address could seem like failure to function but for some it could be an alternative life choice to live ‘off grid’.
E - Similarly, those who partake in high-risk leisure activities could be classed as irrational for their life choices.
L - This means people who make unusual choices are at risk of being labelled abnormal and that could restrict their freedom.
What is another limitation of failure to function adequately?
P - Another limitation of failure to function adequately is that it may not be able to class something as abnormal.
E - This is because there are some circumstances where most of us would fail to cope, for example, in times of bereavement. Due to this it may be unfair to give someone a label that may cause future problems just because of their reaction to difficult times.
L - Therefore it may not always be beneficial to call those who are failing to function abnormal.
What is deviation from ideal mental health?
This is when someone doesn’t meet a set of criteria for good mental health.
The criteria includes aspects which make a person normal rather than focussing on what makes them abnormal.
The picture of how we should be psychologically healthy allows us to identify who deviates from the ideal.
What are the aspects of the criteria for ideal mental health?
In 1958, Marie Jahoda categorised ideal mental health as:
ASPIRE
having no symptoms of distress
- being rational and perceiving ourselves accurately
Self actualisation - aiming for self actualisation
Resistance to stress - coping with stress
Accurate perception of reality - having a realistic view of the world
Positive attitude to self - having good self esteem and a lack of guilt
Autonomy - being independent of other people
- being able to successfully work,love and enjoy our leisure
The criteria shows an overlap between what we call deviation from ideal mental health and failure to function adequately.
What is an advantage of deviation from ideal mental health?
P - One strength of the ideal mental health criterion is that it is highly comprehensive.
E - Jahoda’s concept of ‘ideal mental health’ includes a range of criteria used to distinguish mental health from mental disorders and also covers most reasons why we may seek help for mental health.
E - This means an individual’s mental health can be discussed meaningfully with professionals who are able to take different theoretical views.
L - This means that ideal mental health provides a checklist against which we can assess ourselves and others, as well as allowing us to discuss psychological issues with a professional.
What is a limitation of deviation from ideal mental health?
P - One limitation of the ideal mental health criterion is that its different elements are not equally applicable across a range of cultures.
E - This is because some of Jahoda’s criteria for ideal mental health are based on the US and Europe. For example, self-actualisation would be seen as self-indulgent in most parts of the world.
E - Even in Europe there are variations in the value placed on personal independence, as in Germany its high but in Italy its low.
L - Therefore, it could be difficult to apply the concept of ideal mental health across cultures.
What is another limitation of deviation from ideal mental health?
P - One limitation of deviation from ideal mental health is that the standards are extremely high.
E - This is because very few of us can attain all of Jahoda’s criteria for mental health and some people either can’t achieve them all at the same time or for a long time. This can be disheartening to have to live up to impossible standards.
E - However, having a comprehensive criteria for ideal mental health can help someone work towards improving their mental health.
L - Therefore, it may not be beneficial to have a set criteria for mental health in all cases.
What is a phobia?
Phobias are categorised by excessive and irrational fear and anxiety triggered by an object, place or situation.
The fear is out of proportion to any real danger presented by the phobic stimulus.
What is the DSM?
A system used to classify and diagnose mental health problems. It is updated from time to time as what is classed as abnormal.
We’re currently on the DSM-5.
What are the categories of phobias recognised by the DSM?
Specific phobia - Phobia of an object or situation
Social anxiety - Phobia of a social situation
Agoraphobia - Phobia of being outside or in a public place.
What are behavioural categories of phobias?
Behavioural categories are ways in which people act.
Panic - Panic involves a range of behaviours including crying, screaming or running away. However, children may react differently (freezing, clinging or having a tantrum).
Avoidance - This when a person goes out of their way to prevent coming into contact with the phobic stimulus, which can make it hard to go about day to day life.
Endurance - This is the alternative to avoidance. The person chooses to stay in the presence of the phobic stimulus.
What are emotional categories of phobias?
Emotional categories are related to a person’s feelings or mood.
Anxiety - Phobias are anxiety disorders and they involve an emotional response and an unpleasant state of high arousal.
It prevents a person from relaxing, can be long term and makes it difficult to experience any positive emotion.
Fear - The immediate and extremely unpleasant response we experience when we encounter or think about a phobic stimulus. It is more intense but is more short lived than anxiety.
Emotional response is unreasonable - Anxiety or fear is greater and disproportionate to any threat posed.
What are cognitive characteristics of phobias?
Cognitive refers to the process of ‘knowing’, including thinking, reasoning, remembering and believing. Those with phobias process information about the phobic stimulus differently from other objects or situations.
Selective attention to the phobic stimulus - This makes it hard for a person to remove their attention from the phobic stimulus. Keeping our attention on something dangerous can be good as it allows us to respond quickly to a threat. However, it isn’t good when the fear is irrational.
Irrational beliefs - Someone with a phobia may have unfounded thoughts in relation to the phobic stimulus, which can’t easily be explained and don’t have any basis in reality. These beliefs can increase the pressure on a person.
Cognitive distortions - The perceptions of a person with a phobia may be inaccurate. This means the way they think about the phobic stimulus is unrealistic.
What is the behavioural approach to explaining phobias?
A way of explaining behaviour in terms of what is observable and in terms of learning. This approach focuses on the behavioural characteristics of phobias rather than cognitive or emotional aspects.
What is the two-process model?
Mowrer proposed the two-process model based on the behavioural approach to phobias. This states phobias are acquired by classical conditioning and maintained by operant conditioning.
What is classical conditioning?
Learning by association. It occurs when two stimuli are repeatedly paired. It is when something which we initially have no fear of is paired with something which triggers a fear response.
What study supports classical conditioning in phobias?
Watson and Rayner created a phobia in a 9 month old baby called ‘Little Albert’
At the start of the study, he showed no signs of unusual anxiety.
When showed a white rat he tried to play with it, but whenever it was presented to him experimenters made a loud,frightening noise with an iron bar. Overtime the rat became associated with the loud bang so produced a fear response.
The conditioning was generalised to similar objects (fur coat, a non white rabbit and Watson in a beard made of cotton balls)
What is operant conditioning?
Learning where behaviour is shaped and maintained by consequences. Phobias are long lasting due to operant conditioning because responses solely caused by classical conditioning tend to decline over time.
How is operant conditioning involved in phobias?
Negative reinforcement - An individual could avoid an unpleasant situation which could result in a desirable consequence. Therefore, the behaviour will be repeated.
Mowrer suggests when we avoid a phobic stimulus we escape the fear and anxiety we would’ve experienced if we stayed there.
What is an advantage of the behavioural approach to explaining phobias?
P - One strength of the two process model is its real world application in exposure therapies, such as systematic desensitisation.
E - This is because the distinctive element of the two process model is the idea that phobias are maintained by avoidance of the phobic stimulus.
This is important in explaining why people with phobias benefit from being exposed to the phobic stimulus.
E - Once the avoidance behaviour is prevented, the phobia ceases to be reinforced by the experience of anxiety reduction and avoidance so it declines.
This means when the avoidance is prevented the phobia is cured.
L - This shows the value of the two process approach as it identifies as a means of treating phobias.
What is another strength of the behavioural approach to explaining phobias?
P - Another strength of the two process models is evidence for a link between bad experiences and phobias.
E - The Little Albert shows how a frightening experience involving a stimulus can lead to a phobia.
E - Ad De Jongh et al found that 73% of people with a fear of dental treatment had experienced a traumatic experience with dentistry or had been the victim of a violent crime. This was compared to a control group of people with low dental anxiety where only 21% had experienced a traumatic event.
L - This confirms the association between stimulus and unconditioned response does lead to a phobia.
What is a counterpoint to the link between phobias and traumatic experiences?
P - However, this may not always be the case as not all phobias appear following a bad experience.
E - Some common phobias such as snakes occur in populations where very few people have had real life experience with snakes. In addition, not all frightening encounters lead to phobias.
L - This means that the association between phobias and frightening experiences isn’t as strong as we expect.
What is one more advantage of the behavioural approach of explaining phobias?
P - One advantage is that behavioural models of phobias is that they provide credible individual explanations
E - This is because they can explain how a particular person develops and maintains a phobia.
E - However, there are other more general aspects to phobias that may be better explained by evolutionary theory.
For example, we tend to acquire phobias of things that have presented a danger in our evolutionary past, such as the dark. This is called preparedness
L - Therefore, behavioural models have some usefulness, but evolution plays a part.
What is a limitation of the behavioural approach to explaining phobias?
P - One limitation of the two process model is that it doesn’t account for the cognitive aspect of phobias.
E - This is because behavioural explanations are geared towards explaining behaviour. For phobias the key behaviour is avoidance of the phobic stimulus. However, phobias are not simply just avoidance responses there is also a significant cognitive component.
For example, people who hold irrational beliefs about the phobic stimulus have thoughts about their phobia.
E - The two process model explains avoidance behaviour but doesn’t offer an adequate explanation for phobic cognitions.
L - This means that the two-process model doesn’t completely explain the symptoms of phobias.
What is systematic desensitisation?
Systematic desensitisation is a behavioural therapy designed to gradually reduce an unwanted response, such as anxiety, through classical conditioning.
Once a person can learn to relax in the process of the phobic stimulus they’ll be cured.
Essentially, a new response to the phobic stimulus is learned, this causes the phobic stimulus to be paired with relaxation instead of anxiety (counterbalancing)
What are the three processes involved in systematic desensitisation?
The anxiety hierarchy, relaxation and exposure.
What is the anxiety hierarchy in treating phobias?
A client with a phobia and their therapist put together an anxiety hierarchy. This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening.
What is relaxation in treating phobias?
The therapist teaches the client to relax as much as possible because it is impossible to be afraid and relaxed at the same time, so relaxation prevents fear (reciprocal inhibition).
Relaxation can include breathing exercises, use drugs like Valium or a client may learn mental imagery techniques
What is exposure in treating phobias?
This is the last step where the client is exposed to the phobic stimulus while in a relaxed state. This happens over many sessions which progress up the anxiety hierarchy. Once the client can be relaxed in the presence of lower levels of the phobic stimulus they move up the hierarchy.
Treatment is successful when they can stay relaxed in situations ranked high on the hierarchy.
What is another strength of systematic desensitisation?
P - Another strength of systematic desensitisation is that it can be used to help people with learning disabilities.
E - This is because some people require treatment for phobias and also have a learning disability but the main alternatives to SD are not suitable.
E - 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.
L - This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias.
What is an advantage of systematic desensitisation?
P - One strength of systematic desensitisation is the evidence base for its effectiveness.
E - Gilroy et al followed up 42 people who had SD for arachnophobia in 3 45-minute sessions.
At both 3 and 33 months, the group was less fearful than a control group treated by relaxation without exposure.
E - Recently, Wechsler et al concluded that SD is effective for specific phobia, social phobia and agoraphobia.
L - This means that SD is likely to be helpful for people with phobias.
How does flooding work?
Flooding removes the option of avoidance so it stops the phobic response quickly, this allows the client to know the phobic stimulus is harmless.
In classical conditioning this is called extinction. This is where a learned response is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus.
This results in the conditioned stimulus no longer produces the conditioned response of fear.
This could cause the client to achieve relaxation in the presence of the phobic stimulus as they become exhausted by their own fear response.
What is one more advantage of systematic desensitisation?
P - One advantage is that systematic desensitisation is used in virtual reality.
E - This is because traditional systematic desensitisation involves exposure to the phobic stimulus in a real-world setting. However, there are advantages in conducting the exposure part of SD in virtual reality. This is because virtual reality can avoid dangerous situations and is cost effective as the psychologist and client don’t have to leave the consulting room.
L - Therefore, systematic desensitisation has practical advantages.
What is flooding?
Flooding is 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 is done without a gradual buildup in an anxiety hierarchy.
Flooding sessions take place over a small number of therapy sessions where sessions can take up to 3 hours (longer than SD)
Is flooding ethical?
Flooding isn’t unethical but can be an unpleasant experience so it’s important that clients give fully informed consent to this traumatic procedure and are fully prepared before the session.
What is an advantage of flooding?
P - One strength of flooding is that it is highly cost-effective.
E - Clinical effectiveness means how effective a therapy is at tackling symptoms. A therapy is cost-effective if it is clinically effective and not expensive.
E - Flooding can work in as little as one session as opposed to 10 sessions of SD to achieve the same result. Even allowing for a longer session flooding is still more cost-effective.
L - This means that more people can be treated at the same cost with flooding than with SD.
What is a limitation of flooding?
P - One limitation of flooding is that it is a highly unpleasant experience.
E - This is because confronting someone’s phobic stimulus in an extreme form provokes anxiety.
Schumacher et al 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.
The traumatic nature of flooding means that dropout rates are higher than for SD.
L - This suggests therapists may avoid using this treatment.
What is another limitation of flooding?
P -
E -
L -
What is depression?
A mental disorder characterised by low mood and low energy levels.
What are the categories of depression recognised by the DSM?
Major depressive disorder - severe but often short term depression.
Persistent depressive disorder - long term/ recurring depression, including sustained major depression.
Disruptive mood dysregulation disorder - childhood temper tantrums.
Premenstrual dysphoric disorder - disruption to mood prior to and during menstruation.
What are the behavioural characteristics of depression?
Activity levels - typically reduced levels of energy, making someone lethargic. This could cause people to withdraw from work, education and even social life.
Depression could also lead to the opposite which is psychomotor agitation, where individuals struggle to relax.
Disruption to sleep and eating behaviour - A person could experience reduced sleep, insomnia, or an increased need for sleep, hypersomnia.
Likewise, appetite may increase or decrease, which affects weight.
Aggression and self harm - Those with depression tend to be irritable and can be verbally/ physically aggressive, which can affect their life.
It could also lead to physical aggression against the self.
What are emotional characteristics of depression?
Anger - A strong feeling of annoyance, displeasure and hostility. People with depression sometimes experience extreme anger towards themselves and others. This can lead to aggression and self harm.
Low mood - This is a defining element of depression but is more intense than feeling sad. Those with depression often feel worthless and empty.
Low self esteem - Self esteem is about how much we like ourselves. Those with depression have lower self esteem. This can be quite extreme with some feeling a sense of self loathing, which means they hate themselves.
What are the cognitive characteristics of depression?
Poor concentration - A person with depression may find it hard to stick to a task they usually would be able to or may find decisions that are normally straightforward hard. This is likely to interfere with a person’s life.
Attending to and dwelling on the negative - Someone going through a depressive episode is more inclined to pay attention to negative aspects of a situation and ignore the positives. They also have a bias to recall negative events rather than happy events.
Absolutist thinking - People with depression tend to have black and white thinking where they see a situation as all bad or all good. This could cause them to see an unfortunate situation as a disaster.
What is the cognitive approach to explaining depression?
This approach focuses on how our mental processes, such as thoughts, perceptions and attention affect behaviour.
Beck took a cognitive approach to explain why some people are more vulnerable to depression than others. He believes the way a person thinks causes the vulnerability to depression.
What are the three parts to cognitive vulnerability?
Faulty information processing
Negative self-schema
The negative triad
What is faulty information processing?
This is when depressed people attend to the negative aspects of a situation and ignore positives. Therefore depressed people tend to have black and white thinking.
What is negative self schema?
A schema is a package of ideas and information developed through experience, which people use to help interpret the world. The schema acts as a mental framework for the interpretation of sensory information.
A self schema is the package of information people have about themselves. If a person has a negative self-schema then they interpret everything about themselves negatively.
What is the negative triad?
Beck proposed that there are three kinds of negative thinking that contribute to depression and a dysfunctional view of self regardless of the reality of what is happening at that time.
What are the three types of thinking involved in the negative triad?
Negative view of the world - creates impression there is no hope.
Negative view of the future - reduces hopefulness and enhances depression.
Negative view of the self - enhances any existing depressive feelings as it confirms low self esteem .
What is a strength of Beck’s cognitive explanation of depression?
P - One strength of Beck’s cognitive model of depression is the existence of supporting research.
E - Cognitive vulnerability refers to the ways of thinking that may predispose a person to depression. These could include faulty information processing, negative self schema and the negative triad.
E - Clark and Beck concluded that not only were the cognitive vulnerabilities more common in depressed people but they come before the depression.
A recent study by Cohen et al confirms this. They tracked the development of 473 adolescents and regularly tracked measured vulnerabilities. They found that cognitive vulnerability predicted later depression.
L - This shows that there is an association between cognitive vulnerability and depression.
What is another strength of Beck’s cognitive explanation of depression?
P - Another strength of Beck’s cognitive model of depression is its applications in screening and treatment for depression.
E - Cohen et al concluded that assessing cognitive vulnerability allows psychologists to screen young people and identify those who are most at risk of developing depression in the future so they can be monitored.
E - Through understanding cognitive vulnerability it can also be used and applied in cognitive behavioural therapy(CBT). CBT is where the cognitions which make people vulnerable to depression are altered to make them more resilient to negative life events.
L - This means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice.
What is a limitation of Beck’s cognitive explanation of depression?
P - One limitation of Beck’s cognitive explanation of depression is that it is a partial explanation.
E - Though we know depressed people show particular patterns of cognitions which can be seen before depression, it appears that Beck’s explanation is a partial explanation.
E - There are some aspects to depression that are not particularly well explained by cognitive explanations.
L - This means it isn’t a complete explanation so may not be used alone.
What is the ABC model in depression?
Ellis proposed the ABC model which states that depression occurs when an activating event triggers an irrational belief which produces a consequence, like depression.
He believes good mental health is a result of rational thinking, which is thinking which allows people to be happy and free from pain.
What are irrational thoughts/beliefs?
Thoughts which interfere with us being happy and free from pain.
What is an Activating event?
External situations which trigger irrational thoughts. Ellis believes we get depressed when we experience negative events.
What is an irrational Belief?
Ellis believed there are many irrational beliefs.
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 when something doesn’t go smoothly.
Utopianism is the belief that life is always meant to be fair.
What are consequences?
When an activating event triggers irrational beliefs there are emotional and behavioural consequences.
What is a strength of Ellis’s ABC model of depression?
P - One strength of Ellis’s ABC model is its real world application in the psychological treatment of depression.
E - Ellis’s approach to cognitive therapy is rational emotive behaviour therapy (REBT). This is when a therapist vigorously argues with a depressed person in attempts to alter the irrational beliefs that make them unhappy.
E - David et al found evidence to support the idea that REBT can both change negative beliefs and relieve the symptoms of depression.
L - This means REBT has real world value.
What is a limitation of Ellis’s ABC model of depression?
P - One limitation of Ellis’s ABC model of depression is that it only explains reactive aggression and not endogenous depression.
E - Depression is often triggered by activating life events which are known as reactive depression.
E - However, many cases of depression are not traceable to life events so it’s not obvious why a person becomes depressed at a particular time. This is known as endogenous depression, which Ellis’s model doesn’t explain.
L - This means that Ellis’s model can only explain some cases of depression and is only a partial explanation.
What is another limitation of Ellis’s ABC model of depression?
P - One limitation of Ellis’s ABC model of depression is there are ethical issues.
E - This is because the ABC model of depression is controversial as it places the responsibility of depression solely on the depressed person, which is unfair.
E - However, if used appropriately and sensitively it can make people with depression achieve resilience.
L - This means that the ABC model has to be used carefully in order to avoid controversy.
What is cognitive behaviour therapy?
Cognitive behaviour therapy is a method for treating mental disorders based on both cognitive and behavioural techniques.
It aims to deal with thinking but also looks at behaviour.
What does CBT aim to do?
It aims to help clients test the reality of their negative beliefs.
Therefore, they may set the client homework, for example recording positive moments. This is known as ‘client as scientist’ because the client is investigating the reality of their negative beliefs like a scientist would.
If in future sessions the client says they haven’t experienced any positive moments, the therapist can use the evidence to challenge the statement.
What is the cognitive element of cognitive behaviour therapy?
CBT begins with an assessment where the client and the cognitive behaviour therapist work together to clarify the client’s problems. It identifies thoughts on the negative triad. The client and therapist identify goals for the therapy and create a plan to achieve them.
Something key is they must identify where there are negative or irrational thoughts which would benefit from being challenged.
What is the behavioural element of cognitive behaviour therapy?
CBT also involves working to change negative and irrational thoughts and putting effective behaviours into place (behavioural activation).
What is Ellis’s rational emotive behaviour therapy?
Rational emotive behaviour therapy (REBT) extends the ABC model to ABCDE.
In this D stands for ‘dispute’ and E ‘effect’
The central technique of REBT is to identify and dispute irrational thoughts.
It involves vigorous arguments to challenge the irrational belief. The aim is to break the link between negative life events and depression.
What are the different methods of disputing?
Empirical arguements - disputing whether there is actual evidence to support the negative belief.
Logical arguements - disputing whether the negative thought logically follows from the fact.
What does Ellis see as irrational thoughts?
Thoughts which are likely to interfere with a person’s happiness.
What does behavioural activation mean in treatments for depression?
As people become depressed, they avoid difficult situations and become isolated. This allows symptoms to be maintained or worsened.
Behavioural activation works with depressed individuals to gradually decrease their avoidance and isolation. It increases their engagement in activities which are shown to improve moods (exercising and going out to eat). The therapist aims to reinforce that behaviour.
What is an advantage of cognitive behaviour therapy?
P - One strength of CBT is the large body of evidence supporting its effectiveness for treating depression.
E - March et al compared CBT to antidepressant drugs and a combination of both treatments when treating 327 depressed adolescents.
After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group had significantly improved.
E - This shows that CBT was just as effective when used on its own and was more effective alongside antidepressants.
CBT is a fairly brief therapy which requires 6-12 sessions so is cost effective.
L - Therefore, CBT is widely seen as the first choice of treatment in public health care systems such as the NHS.
What is a limitation of cognitive behaviour therapy?
P - One limitation of CBT for depression is the lack of effectiveness for severe cases and those with learning disabilities.
E - Sometimes 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.
E - The complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities.
Sturmey suggests that any form of talking therapy isn’t suitable for people with learning disabilities.
L - This suggests that CBT may only be appropriate for a specific range of people with depression.
What is a counterpoint for CBT’s lack of diversity amongst different types of clients?
P - However, there is more recent evidence with conflicts with the idea that CBT is unsuitable for very depressed people and those with learning disabilities.
E - Lewis and Lewis found that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression.
E - Taylor et al found that when CBT is used appropriately it is effective for people with learning disabilities.
L - This means that CBT may be suitable for a wider range of people than was once thought.
What is another limitation for cognitive behaviour therapy?
P - A further limitation of CBT is there are high relapse rates.
E - Though CBT is effective in tackling the symptoms of depression, there are concerns about how long the benefit lasts.
There are few early studies of CBT which look at its long term effectiveness.
E - More recent studies suggest that long term outcomes aren’t as good as assumed. Ali et al assessed depression in 439 clients every month for 12 months after CBT.
42% had relapsed into their depression within 6 months of ending treatment and 53% relapsed within a year.
L - This means CBT may need to be repeated periodically.
What is another strength of cognitive behaviour therapy?
P - Another strength of CBT is that it is effective
E - CBT focuses on identifying and changing unhelpful patterns of thinking. There is a lot of evidence to show when used appropriately it can tackle the symptoms of depression, which makes it effective.
E - However, not all clients would want to tackle their depression in this way. This is because some people just want their symptoms to go as quickly and as soon as possible. They would prefer medication. Survivors of trauma may want to study the origins of their symptoms.
Yrondi et al found that depressed people rated CBT as their least preferred psychological therapy.
L - Therefore it could be argued the effectiveness of CBT is dependent on client preference.
What is Obsessive compulsive disorder?
A condition characterised by obsessions and/or compulsive behaviour. Most people with OCD experience both obsessions and compulsions.
Obsessions are cognitive.
Compulsions are behavioural.
What are the categories of OCD recognised by the DSM?
OCD
Trichotillomania - compulsive hair pulling
Hoarding disorder - the compulsive gathering of possessions and the inability to part with anything, regardless of value
Excoriation disorder - compulsive skin picking
What are the behavioural characteristics of OCD?
Compulsions are repetitive - people with OCD feel compelled to complete a behaviour.
Compulsions reduce anxiety - Around 10% of people with OCD show compulsive behaviour alone with no obsessions, just a general sense of irrational anxiety. However, for many compulsions are managed anxiety produced by obsessions.
Avoidance - People with OCD attempt to reduce anxiety by keeping away from situations that trigger it. This can lead people to avoid very ordinary situations, which interferes with living a regular life.
What is the cycle of OCD
Obsessions lead to Anxiety which leads to a compulsive behaviour which leads to temporary relief. This cycle continues.
What are the emotional characteristics of OCD?
Anxiety and distress - OCD is a rather unpleasant emotional experience as it is accompanied by powerful anxiety for both compulsions and obsessions. Obsessive thoughts can be frightening and unpleasant, which causes distress and a sense of being overwhelmed. The urge to repeat a compulsion can create anxiety.
Accompanying depression - OCD is often accompanied with depression. This means anxiety can be accompanied with a low mood and lack of enjoyment in activities.
Guilt and disgust - OCD can lead to irrational guilt (for example, over minor moral issues) or disgust which may be directed against something external or at self
What are the cognitive characteristics of OCD?
Obsessive thoughts - For around 90% of people with OCD the major cognitive feature of their condition is obsessive thoughts which are recurring. They vary across people but are unpleasant.
Cognitive coping strategies - Obsessions are responded to by adopting cognitive coping strategies to deal with the obsessions. These can help manage anxiety but can make the person appear abnormal to others, as well as distracting them from everyday tasks.
Insight into excessive anxiety - People with OCD are aware that the obsessions and compulsions they experience aren’t normal, which is a necessary aspect of OCD diagnosis. If they believed this is normal that would be another mental disorder. However, people with OCD experience catastrophic thoughts about the worst case scenarios which would occur if their anxieties are justified. They are also hypervigilant and keep focused on potential hazards
What is the biological approach to explaining OCD?
A perspective that emphasises the importance of physical processes in the body such as genetic inheritance and neural function on OCD.
Some mental disorders appear to have a stronger biological component than others.
What is the genetic explanation of OCD?
Genes make up chromosomes and consist of DNA which codes for physical features of an organism and psychological features.
Genes are inherited and are involved in individual vulnerability to OCD.
What study supports the claim that OCD is genetically inherited?
Lewis observed that of his OCD patients, 37% had parents with OCD and 21% had a sibling with OCD.
This suggests that OCD runs in families. However, it’s not OCD that is passed down generations but the genetic vulnerability.
What does the diathesis stress model say about depression being genetically inherited?
This claims that certain genes leave some people more likely to develop a mental disorder but it is not certain. An environmental stressor is necessary to trigger the condition.
Therefore, the genes which make a person vulnerable to OCD can be passed down but a situation must take place to activate the condition.
What are candidate genes?
Genes which create a vulnerability for OCD. Some of these genes are involved in regulating the development of the serotonin system.
What does polygenic mean in OCD?
OCD is not caused by one single gene but by a combination of genetic variations that significantly increases vulnerability.
Taylor analysed findings of previous studies and found evidence that up to 230 different genes may be involved in the development of OCD. Some genes which have been studied in relation to OCD include those linked to dopamine and serotonin, which are both neurotransmitters believed to regulate mood.
What does aetiologically heterogeneous mean in OCD?
Aetiologically heterogeneous means that the origins of OCD vary from one person to another.
Due to this one group of genes may cause OCD in one person but a different group of genes could cause OCD in another person.
There is evidence which suggests that different types of OCD may be the result of particular genetic variations.
What is a strength of the genetic explanation of OCD?
P - One strength of the genetic explanation of OCD is the strong evidence base.
E - There is evidence from many sources which suggest that some people are vulnerable to OCD as a result of their genes. This can be shown in twin studies.
Nestadt et al reviewed twin studies and found that 68% of monozygotic twins(identical) both had OCD. Whereas, 31% of dizygotic twins(non-identical) both had OCD.
E - Another source of evidence is family studies.
Marini and Stebnicki found that a person with a family member who is diagnosed with OCD is around 4x as likely to develop OCD in comparison to someone without
L - This shows that there must be some genetic influence on the development of OCD.
What is another strength of the genetic explanation of OCD?
P - Another strength of the genetic explanation of OCD is that there is evidence from animal studies.
E - It is difficult to find candidate genes but Ahmari found evidence from animal studies which show that particular genes are linked with repetitive behaviours in other species, such as mice.
E - However, although mice and humans share most genes, the human mind and brain are much more complex.
L - This means it may not be possible to generalise animal repetitive behaviour to human OCD.
What is a limitation of the genetic explanation of OCD?
P - One limitation of the genetic explanation of OCD is that there are also environmental risk factors.
E - There is strong evidence for the idea that genetic variation can make a person less or more vulnerable to OCD.
E - However, OCD doesn’t appear to be entirely down to genetics, it seems like environmental risk factors can also trigger or increase the risk of developing OCD.
Cromer et al found that over half the OCD clients in their sample had a traumatic event in their past. OCD was also more severe in those with one or more traumas.
L - This means that genetic vulnerability only provides a partial explanation for OCD.
What is the neural explanation of OCD?
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.
The genes linked with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain.
What is the role of serotonin in OCD?
Serotonin is a neurotransmitter which helps to regulate mood. Neurotransmitters relay information from one neuron to another.
Low levels of serotonin means normal transmission of mood-relevant information doesn’t take place and a person may experience low moods. It could also affect other mental processes.
In some cases of OCD, it can be explained by a reduction in the functioning of the serotonin system in the brain
Is decision making involved in OCD?
Impaired decision making is linked to some cases of OCD, especially hoarding disorders. This could also be linked to abnormal functioning of the frontal and lateral lobes of the brain - the frontal lobes are responsible for logical thinking and decision making.
There is also evidence that shows that the left parahippocampal gyrus is linked to processing unpleasant emotions and functions abnormally in OCD.
What is a strength of the neural explanation of OCD?
P - One strength of the neural model of OCD is the existence of some supporting evidence.
E - Antidepressants that work only on serotonin are effective in reducing OCD symptoms which suggests serotonin may be involved in OCD.
E - Nestadt et al found that OCD symptoms form part of conditions that are known to be biological, such as the degenerative brain disorder, Parkinson’s disease, which causes tremors and paralysis.
If a biological disorder produces OCD symptoms, we may assume the biological processes underline OCD.
L - This suggests that biological factors such as serotonin may be responsible for OCD.
What is a limitation to the neural explanation of OCD?
P - One limitation of the neural explanation of OCD is that the link between serotonin and OCD may not be unique to OCD.
E - Many people with OCD experience co-morbidity, which is where a person has two disorders at the same time. People with OCD tend to also suffer with clinical depression. This depression can involve disruption to the action of serotonin.
This could cause a logical problem of whether serotonin activity is disrupted in people with OCD because of their depression.
L - Therefore, serotonin may not be relevant to OCD symptoms.
What is another limitation of the neural explanation of OCD?
P - One limitation of the neural explanation of OCD is it may be looking at correlation not causation.
E - There is evidence that shows that some neural systems, like serotonin, don’t work normally in people with OCD. According to the biological model of mental disorder this is explained by brain dysfunction causing OCD.
E - However, that is only a correlation between neural abnormality and OCD but doesn’t indicate a causal relationship.
L - This mean that neural abnormality may not cause OCD and there may be a third factor acting as a influencer.
