Psychopathology Flashcards
Whats psychpathology
Psychopathology is the scientific study of psychological disorder
- psycho for psychological
- and pathology, wch means study of the causes of diseases.
In the case of physical disorders,
- doctors identify certain signs and symptoms to determine when one is ill.
-
- In case of psychological disorders, the issue = how do we identify when someone is ‘ill’
- in what way does their behaviour differ from what’s normal, i.e. is it abnormal?
How is abnormality described as a deviation from social norms ?
Most of us notice ppl whose behaviour is a deviation from social norms,
- i.e. wher we act diff from how we expect people to behave.
Groups of people (hence social norms) choose to define behaviour
- as abnormal on basis that it offends sense of what is ‘acceptable’ or the norm. - We are making a collective judgement as a society about what is right.
-
Norms are specific to culture we live in
- Of course those social norms may be diff for each generation and every culture,
- so there is relatively little behaviour thats considered universally abnormal
- on the basis that they breach social norms.
> Eg, homosexuality continues to be viewed as abnormal in some cultures
> was considered abnormal in our society in the past.
How is antisocial personality disorder an example of deviation from social norms
A person with antisocial personality disorder (psychopathy) is impulsive, aggressive and irresponsible.
- According to tDSM-5 (the manual used by psychiatrists to diagnose mental disorder)
- an important symptom of antisocial personality disorder is
- an ‘absence of prosocial internal standards associated with
failure to conform to lawful or culturally normative ethical behaviour’.
»_space; In other words we make the social judgement that
»_space; a psychopath is abnormal as they don’t conform to our moral standards.
> Psychopathic behaviour wd be considered abnormal in a very wide range of cultures.
EVALUATION of deviation from social norms as describing abnormality
— can be used to justify removal of ‘unwanted ppl’ from society.
- eg, opposing a particular political regime cd be said to be abnormal.
— what is considered acceptable or abnormal can change over time.
- eg, recently as 1974, homosexuality was classified in the
- Diagnostic and Statistical Manual of Mental Disorders (DSM) as a disorder
- But, the diagnosis was dropped as homosexuality wasn’t as infrequent as thought,
- homosexuals dont differ from heterosexuals in psychological well-being
How do we describe abnormality as failing to function adequately
A person may cross the line between ‘normal’ and ‘abnormal’
- when they cant fulfill demands of everyday life
- and they fail to function adequately.
We might decide that someones functioning adequately
- when are unable to maintain basic standards of nutrition and hygiene.
- also are not functioning adequately if cant hold down a job/maintain relationships with ppl round them.
..
• When is someone failing to function adequately?
Rosenhan and Seligman (1989) proposed some signs that are used to determine when one is not coping.
1) When one no longer conforms to standard interpersonal rules, eg eye contact and respecting personal space.
2) When one experiences severe personal distress.
3) When one’s behaviour becomes irrational/dangerous to themselves or others.
Eg. intellectual disability disorder
- One criteria is having a very low IQ (a statistical infrequency).
- But a diagnosis wd not be made on this basis only - one must also be failing to function adequately before diagnosis given.
EVALUATION of failure to function adequately as describing abnormality
- Is it simply a deviation from social norms
In practice, can be hard to say when one is really falling to function
and when they are just deviating
• judgements
- When deciding if one is failing to function adequately, one has to judge if a patient is distressed.
> Some may say they are distressed but may be judged as not suffering.
> very subjective
>
+ BUT this definition recognises subjective experience of the patient,
allowing us to view mental disorder from pov of person experiencing it.
+ are methods of making such judgements as objective as possible
»_space; as we can list behaviours (can dress self, can prepare meals)
- from tools like the Global Assessment of Functioning Scale.
>
whats statistical infrequency/how can abnormality be described as a deviation from statistical norms
An obvious way to define anything as ‘normal” or ‘abnormal’
is according to number of times we observe it - statistics are about numbers.
According to the statistical definition
- any relatively usual behaviour/characteristics can be thought of as ‘normal’,
and any behaviour that is diff to this is ‘abnormal’.
>
> This is statistical infrequency.
We can, eg, say at any one time only a small number of people will have an irrational fear of buttons.
..
Example: IQ and intellectual disability disorder
- This statistical approach comes in when dealing with characteristics that can be reliably measured, intelligence.
- We know, in any human characteristic, most ppls scores will cluster round average,
- and the further we go above/below average, the fewer people will attain that score.
This is called the normal distribution.
diagram 1
What are problems describing abnormality in terms if statistical frequency
— doesn’t take account of desirability of behaviour, its just frequency.
- eg, a very high IQ is abnormal, as is a very low one,
- but a high IQ is desirable unlike a low one.
- is statistically abnormal but but doesnt always mean it requires treatment
— There’s no definite cut-off point where normal behaviour becomes abnormal behaviour.
— Some behaviours considered psychologically abnormal are quite common (e.g. mild depression.)
- Hassett and White (1989) argue you cant use statistical infrequency
- to define abnormality bc some abnormal behaviours are common.
How do we describe abnormality as a Deviation from ideal mental health
A diff way to look at normality/abnormality is to ignore issue of what makes one abnormal
but think abt what makes one ‘normal’.
> Ie we can consider deviation from ideal mental health.
Once we have ideas of being psychologically healthy we can begin to identify who deviates from this idea.
> Abnormality is absence of criteria for good mental health (as in physical illness).
> The more criteria are missing the more serious the abnormality.
..
What does ideal mental health look like?
Jahoda (1958) said we are in good mental health if we meet following criteria:
• We have no symptoms of distress
• We are rational and can perceive ourselves accurately
• We self-actualise (reach our potential)
• We can cope with stress
• We have a realistic view of the world
• We have good self-esteem and lack guilt
• We are independent of other people
• We can successfully work, love, enjoy our leisure
Inevitably theres overlap between
- what we call deviation of social norms
- and what we call failure to function adequately.
So we think of one’s inability to keep a job
as a failure to cope with pressures of work
or as a deviation from ideal of successfully working.
Evaluation of deviation from ideal mental health as a description of abnormality
+ It is a comprehensive (dealing with all elements) definition
• covers a broad range of criteria for mental health.
- probably covers most reasons one wd seek/referred for help from mental health services
- range of factors discussed in relation to Jahoda’s ideal mental health
- make it a good tool for thinking about mental health.
— sets unrealistically high standards for mental health
- Very few attain all Jahoda’s criteria for mental health, and
- none of us achieve all at same time/keep them up for long.
-
+ BUT shows ppl the ways they cd benefit from seeking treatment
- say counselling - to improve their mental health.
— they’re subjective
- the ideas of what is required for each will differ from person to person.
What are phobias
All phobias are characterized by excessive fear/anxiety
> triggered by objects, places or situations
>
> in phobias, the extent of the fear is out of proportion
to any real danger presented by the phobic stimulus
DSM(5) recognises these categories of phobia and related anxiety disorder
• Specific phobia:
phobia of an object, like an animal or body part,
or a situation like flying or having an injection.
• Social anxiety (social phobia):
phobia of a social situation
Like public speaking or using public toilet.
• Agoraphobia:
phobia of being outside or in public place.
Behavioural characteristics of PHOBIAS
Behavioural: ways in which people act
We respond to things/situations we fear by behaving in particular ways.
> by feeling high levels of anxiety and trying to escape.
> The fear responses in phobias are same as we experience for any other fear
> even if level of fear is irrational - out of all proportion to the phobic stimulus.
..
1) Panic
A phobic person may panic in response to presence of phobic stimulus.
- Panic may involve behaviours like crying, screaming or running away.
- Children may react slightly differently, like by freezing, clinging or having a tantrum.
2) Avoidance
Unless the sufferer is making a conscious effort to face the fear
- they tend to go to a lot of effort to avoid contact with stimulus.
- This can make it hard to go about daily life.
3) Endurance
The alternative to avoidance is endurance, - in wch a sufferer remains in presence of the phobic stimulus
- but continues to experience high levels of anxiety.
- may be unavoidable in some situations, eg for a person who has an extreme fear of flying.
Emotional characteristics of PHOBIAS
Emotional: ways in which people feel
1) Anxiety
Phobias are classed as anxiety disorders.
- they involve an emotional response of anxiety and fear.
- Anxiety is an unpleasant state of high arousal;
> prevents sufferer relaxing and makes hard to experience positive emotion.
Anxiety can be long term.
Fear is the immediate and unpleasant response we experience
when encounter/think of phobic stimulus.
..
2) Example: arachnophobia
Matt has a phobia of spiders
> anxiety levels increase whenever enters a place associated with spiders - eg his own garden shed.
> This anxiety is a general response to the situation.
When he actually sees a spider he experiences fear
- a very strong emotional response directed particularly towards spider itself.
..
3) Emotional responses are unreasonable
The emotional responses we feel due to phobic stimuli go past whats reasonable.
> So, eg Matt’s fear of spiders involves a strong emotional response to a tiny and harmless spider.
> is wildly disproportionate to danger posed by any spider Matt may meet in his shed.
Cognitive characteristics of PHOBIAS
Cognitive: the process of thinking - knowing, perceiving, believing.
The cognitive element is concerned with
ways ppl process info abt phobic stimuli diff from other objects or situations.
..
1)Selective attention
If a sufferer can see phobic stimulus its hard to look away from.
- Keeping our attention on smth dangerous is a good thing as gives is best chance of reacting quick to a threat
- but not so useful when fear is irrational.
A pogonophobic will struggle to concentrate on what they are doing
if theres someone with a beard in room.
..
2)Irrational beliefs
A phobic may hold irrational beliefs in relation to phobic stimuli.
- eg, social phobias can involve beliefs like ‘I must always sound intelligent’ or ‘If I blush people will think I’m weak.
- This belief increases pressure on sufferer to perform well in social situations.
..
3)Cognitive distortions
The phobic’s perceptions of phobic stimulus may be distorted.
- So, eg, an omphalophobic is likely to see belly buttons as ugly/disgusting,
- and an ophidiophobic may see snakes as alien/aggressive looking.
Whats depression?
All forms of depression and depressive disorders
are characterised by changes to mood.
- The latest version of DSM (DSM-5)
recognises following categories of depression and depressive disorders.
• Major depressive disorder:
- severe but often short-term depression.
• Persistent depressive disorder:
- long-term or recurring depression, including sustained major depression
- and what used to be called dysthymia (mild but long-term depression).
• Disruptive mood dysregulation disorder:
- childhood temper tantrums.
• Premenstrual dysphoric disorder:
- disruption to mood prior to and/or during menstruation.
Behavioural characteristics of DEPRESSION
Behavioural: ways in which people act
Behaviour changes when we suffer an episode of depression
1) Activity levels
Typically sufferers of depression have reduced levels of energy,
- introducing knock-on effect, with sufferers withdrawing from work, education and social life.
- can be so severe that the sufferer cannot get out of bed.
In some cases depression can lead to opposite effect
- known as psychomotor agitation. Agitated individuals struggle to relax and may end up pacing up and down a room.
..
2)Disruption to sleep and eating behaviour
Depression is associated with changes to sleeping behaviour.
- Sufferers 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/loss.
> such behaviours are disrupted by depression.
..
3)Aggression and self-harm
Sufferers of depression are often irritable, and can be verbally/physically aggressive.
- may have serious knock-on effects on a number of aspects of their life.
- like one experiencing depression may display verbal aggression by ending a relationship/quitting a job.
Depression can also lead to physical aggression directed against self.
This includes self-harm/suicide attempts.
Emotional characteristics of DEPRESSION
Emotional: ways in which people feel
1)Lowered mood
the word ‘depressed in everyday life describes having a lowered mood, ie feeling sad.
> Theres more to clinical depression than this.
Lowered mood is still a defining emotional element of depression
- but more pronounced than in daily experience of feeling lethargic and sad.
- Patients describe themselves as ‘worthless’/’empty’
..
2) Anger
Although sufferers experience more negative/fewer positive ones in episodes of depression,
- this experience of negative emotion is not limited to sadness.
- Sufferers also experience anger, sometimes extreme.
- can be directed at self or others.
..
3) Lowered self-esteem
Self-esteem is emotional experience of how much we like ourselves.
- Sufferers of depression tend to report reduced self-esteem
- This can be quite extreme, with some sufferers of depression describing a sense of self-loathing, i.e. hating themselves.
Cognitive characteristics of DEPRESSION
Cognitive: the process of thinking - knowing, perceiving, believing.
The cognitive aspect of depression is concerned with ways ppl process info.
- Ppl suffering/suffered from it process info abt several aspects of world
- differently from normal ways those without depression think
..
1)Poor concentration
Depression is associated with poor levels of concentration.
- sufferer may find themselves unable to stick with a task as usually would,
- or may find it hard to make decisions that they wd normally find easy.
- Poor conc and decision making are likely to interfere with the individual’s work.
..
2)Attending to and dwelling on the negative
- When suffering a depressive episode ppl pay more attention to negative than happy povs
- they have a bias to recalling negative events than happy; the opposite bias that most people have when not depressed.
..
3)Absolutist thinking
Most situations are not all-good or all-bad,
- but when a sufferer is depressed they tend to think in these terms.
> ‘black and white thinking’.
This means that when a situation is unfortunate they tend to see it as an absolute disaster.
Whats OBSESSIVE COMPULSIVE DISORDER (OCD)
The DSM system recognises OCD and a range of related disorders.
> these disorders have in common a repetitive behaviour accompanied by obsessive thinking.
• OCD:
- characterised by either obsessions (recurring thoughts, images, etc.)
- and/or compulsions (repetitive behaviours such as hand washing).
- Most ppl with OCD have both obsessions and compulsions.
• Trichotillomania:
- compulsive hair pulling.
• Hoarding disorder:
- the compulsive gathering of possessions
- and the inability to part with anything, regardless of its value.
• Excoriation disorder: compulsive skin picking.
Behavioural characteristics of ocd
Behavioural: ways in wch ppl act
• Compulsions
The behavioural component of OCD is compulsive behaviour.
Are 2 elements to compulsive behaviour:
- Compulsions are repetitive:
- typically sufferers of OCD feel compelled to repeat behaviour. (Eg hand washing.)
- Other common compulsive repetitions are counting, praying, tidying/ordering groups of objects such as CD collections or containers in a food cupboard. - Compulsions to reduce anxiety:
- around 10% with OCD show compulsive behaviour alone
- they have no obsessions, just a general sense of irrational anxiety.
-
- BUT, for most compulsive behaviours are performed in attempt to manage anxiety produced by obsessions.
- eg, compulsive hand washings are a response to obsessive fears of germs.
- Compulsive checking that a doors locked or a gas appliance is switched off, is response to obsessive thought that it might have been left unsecured.
..
• Avoidance
The behaviour of OCD sufferers may also be characterised by their avoidance
- as try reduce anxiety by keeping away from situations that trigger it.
- Sufferers of OCD try manage OCD by avoiding situations that trigger anxiety,
-
- eg sufferers who wash compulsively may avoid coming into contact with germs.
- BUT, this avoidance can lead ppl to avoid ordinary situations, like emptying bins,
- so itself interfere with a normal life
Emotional characteristics of OCD
Emotional: ways in which people feel
• Anxiety and distress
OCD is regarded as a particularly unpleasant emotional experience
- Due to anxiety that accompanies both obsessions and compulsions.
-
- Obsessive thoughts are unpleasant and frightening, and anxiety that goes with these can be overwhelming.
- The urge to repeat a behaviour (a compulsion) creates anxiety.
..
• Accompanying depression
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 is temporary.
..
• Guilt and disgust
- As well as anxiety and depression, OCD can involve other negative emotions
- such as irrational guilt eg over minor moral issues,
- or disgust, wch may be directed against something external like dirt or at the self.
Cognitive characteristics of OCD
Cognitive: the process of thinking - knowing, perceiving, believing.
The cognitive approach is concerned with ways people process information.
> Ppl with OCD are plagued with obsessive thoughts but also adopt cognitive strategies to deal with them.
• Obsessive thoughts
For round 90% of OCD sufferers the major cognitive feature of their condition is obsessive thoughts,
- i.e. thoughts that recur over and over again.
- These vary from person to person but are always unpleasant.
- eg recurring thoughts are worries of being contaminated by dirt/germs
- or that a door has been left unlocked.
..
• Cognitive strategies to deal with obsessions
Obsessions are the major cognitive aspect of OCD,
- but ppl also respond by adopting cognitive coping strategies.
-
- eg, a religious person tormented by obsessive guilt may respond by praying or meditating.
- may help manage anxiety but can make person appear abnormal to others
- and can distract them from everyday tasks.
..
•Insight into excessive anxiety
ppl with OCD are usually aware that their obsessions/compulsions are not rational.
- This used to be a necessary characteristic for diagnosis,
- BUT recently there is a appreciation that amt of insight can vary between people
- and in the person across time/ situations. -
- eg, OCD sufferers may experience catastrophic thoughts abt worst case scenarios
- that might result if their anxieties were correct.
- also tend to be hypervigilant, i.e. they maintain constant alertness; keep attention on potential hazards.
Whats the behavioural approach to explaining phobias ; two process model and classical conditioning
The behavioural approach suggests that all behaviour is learned.
> For that reason its sometimes called the learning theory
> behaviourists use the word conditioning to mean learning; So smth thats unconditioned is unlearned and vice versa
..
• The Two-process model
The behavioural approach emphasises role of learning in acquisition of behaviour - The approach focuses on behaviour we can see.
- the key behavioural aspects of phobias are avoidance, endurance and panic.
- and The behavioural approach specifically is geared to explaining these
Hobart Mower (1960) proposed the two-process model
based on behavioural approach to phobias.
> states phobias are acquired by classical conditioning; continue due to operant conditioning.
> Acquisition by classical conditioning
involves learning to associate something of wch we initially have no fear (NS)
- with smth that already triggers fear response (UCS).
Watson and Raynor (1920) created a phobia in a 9-month-old baby called ‘Little Albert’.
- showed no unusual anxiety at the start of the study.
- When shown a white rat he tried to play with it.
BUT, experimenters gave Albert a phobia of fluffy things by association
How does the behavioural approach explain phobias with two process model (operant conditioning)
• Maintenance by operant conditioning
- Responses acquired by classical conditioning tend to decline over time.
-BUT, phobias are often long lasting.
Mower has explained this as result of operant conditioning
- Operant conditioning happens when our behaviour is reinforced
(encouraged i.e, rewarded) or punished.
- Positive and Negative Reinforcement tends to increase the frequency of a behaviour.
-
- In negative reinforcement an individual avoids a situation that is unpleasant.
> Such behaviour results in desirable consequence, wch means behaviour will be repeated.
Mower suggested whenever we avoid a phobic stimulus
we successfully escape fear and anxiety we wdve suffered if we had remained.
> reduction in fear reinforces avoidance behaviour and so phobia is maintained.
EVALUATION of the behavioural approach to EXPLAINING phobias
+ A good explanation
The two-process model was a step forward when proposed in 1960
as went beyond Watson and Rayner’s concept of classical conditioning.
- explained how phobias are maintained over time
- had important implications for therapies as explains why patients need to be exposed to feared stimulus.
..
— An incomplete explanation of phobias
According to two-process model of phobias,
- an association between NS and a fearful experience will result in a phobia.
- BUT, research has found, eg, that not all bitten by a dog develop a dog phobia.
- could be explained by the diathesis-stress model;
-
- proposes we inherit genetic vulnerability for developing mental disorders.
BUT, a disorder will only manifest itself if triggered by life event, like bitten by a dog.
- So a dog bite wd only lead to phobia in ppl with a vulnerability.
..
— What abt cognitive aspects of phobias?
- behavioural explanations are abt explaining behaviours, not cognition.
- is why two-process model explains maintining phobias in terms of avoidance.
- But phobias have cognitive elements too.
» so incomplete
Whats the behavioural approach to treating phobias (systematic desensitisation)
• Systematic desensitisation
> SD is a behavioural therapy designed to gradually reduce phobic anxiety
through principle of classical conditioning.
>
> If sufferer learns to relax in presence of phobic stimulus they will be cured.
> Essentially a new response to phobic stimulus is learned (phobic stimulus is paired with relaxation not anxiety).
»_space; This learning of a diff response is counterconditioning
Also, it is impossible to be afraid and relaxed at same time,
so one emotion prevents other.
»_space; This is called reciprocal inhibition.
..
There are three processes involved in SD:
1. The anxiety hierarchy
- put together by patient and therapist.
- a list of situations related to phobic stimulus that provoke anxiety
- in order from least to most frightening.
-
- Eg, an arachnophobic identifies seeing a small spider as low on anxiety hierarchy
- holding a tarantula at top of hierarchy.
- Relaxation.
- The therapist teaches patient to relax as deeply as possible.
- may involve breathing exercises / patient may learn mental imagery techniques.
- Patients are taught to imagine relaxing situations, or may learn meditation.
-
- Alternatively relaxation can be achieved using drugs such as Valium. - Exposure.
- Finally the patient is exposed to phobic stimulus in a relaxed state.
- takes place across several sessions, starting at bottom of the anxiety hierarchy.
-
- When patient can stay relaxed in lower levels of the phobic stimulus
- they move up hierarchy.
- Treatment is successful when patient stays relaxed in high hierarchy sits.
Whats the second behavioural approach to phobia treatment (flooding)
Flooding
> involves exposing patients to phobic stimulus
without build-up in an anxiety hierarchy.
> involves immediate exposure to frightening situation.
> Eg. arachnophobic has a large spider crawl over them for an extended period.
Flooding sessions are longer than systematic desensitisation sessions,
one session lasting 2/3 hours.
> Sometimes only one’s needed to cure a phobia.
..
• How does flooding work?
- Flooding stops phobic responses quickly. - since patient hasnt got the option of avoidance behaviour,
- patient quickly learns that phobic stimulus is harmless.
»_space; In classical conditioning terms
this process is extinction.
-
- A learned response is extinguished when the CS (e.g. a dog)
- is encountered without UCS (e.g. being bitten).
- result is CS no longer produces CR (fear).
In some cases, patient may achieve relaxation in presence of phobic stimulus
- since they become exhausted by their own fear response.
..
• Ethical safeguards
Flooding isnt unethical but is an unpleasant experience
- so is important patients give fully informed consent to traumatic procedure
- so are prepared before flooding session.
-
- A patient wd normally be given the choice
of systematic desensitisation or flooding.
EVALUATION of the behavioural approach to TREATING phobias
+ It is effective/research support
- Research shows SD is effective in the treatment of specific phobias.
- Gilroy et al. followed up patients treated for spider phobia in three 45-minute sessions of SD.
-
- Spider phobia was assessed on several measures
- including Spider Questionnaire and by assessing response to a spider.
- A control group was treated by relaxation without exposure.
- At both 3 months and 33 months after treatment SD group were less fearful than relaxation group.
..
+ It is suitable for a diverse range of patients
- The alternative to SD - flooding/cognitive therapies - arent suited to some patients.
- eg some sufferers of anxiety disorders like phobias also have learning difficulties.
-
- Learning difficulties can make it hard to understand what happens in flooding
- or to engage with cognitive therapies that require ability to reflect on what you are thinking.
- For these patients SD is probably the most appropriate treatment.
..
— Not appropriate for all phobias
- Ohman et al suggests that SD may not be as effective in treating phobias
- that have an underlying evolutionary survival component
- (e.g, dark, heights or dangerous animals) - than in phobias wch were acquired as a result of personal experience.
..
+ It is cost-effective
- Flooding is as effective as other treatments for specific phobias.
- Studies comparing flooding to cognitive therapies have found flooding is highly effective and quicker than alternatives.
- This quick effect is a strength as means patients are free of symptoms asap
- so makes treatment cheaper.
Whats the cognitive approach to explaining depression (becks negative triad)
The emphasis of cognitive approach is on how thinking shapes our behaviour
- opposite to behavioural approach where concept of the mind is ignored.
- Cognitive psychologists are concerned with how irrational thinking
leads to a mental disorder.
..
Beck’s negative triad
> Beck (1967) suggested a cognitive approach, explaining why some are more vulnerable to depression than others.
- Its a person’s cognitions that create this vulnerability,
- i.e. the way they think.
- Beck said depressed individuals feel as they do as their thinking is
- biased to negative interpretations of world; lack a perceived sense of control.
• Faulty information processing
When depressed we attend to negative aspects of sits; ignoring positives.
- We also tend to blow small problems out of proportion
- and so think in ‘black and white’ terms.
• Negative self-schemas
- A schema is a ‘package’ of ideas and info developed through experience.
- act as a mental framework for interpretation of sensory information.
-
- A self-schema is the package of info of ourselves.
- We use schemas to interpret the world, so with negative self-schemas
- we interpret info of ourselves negatively.
..
• The negative triad
One develops a dysfunctional view of themselves
> due to 3 types of negative thinking that occur automatically,
> regardless of reality of what is happening at the time.
> The 3 elements are the negative triad.
Whats another way the cognitive approach explains depression (ellis’ ABC model)
Ellis’s ABC model
> Ellis suggested proposed that good mental health is result of rational thinking,
> defined as thinking in ways that allow people to be happy/free of pain.
>
>To him, anxiety/depression (poor mental health) are from irrational thoughts.
> defined irrational thoughts, not as illogical/unrealistic thoughts,
> but as thoughts that interfere with us being happy/free of pain.
used ABC model to explain how irrational thoughts affect behaviour/emotional state.
..
• A Activating event
- Whereas Beck’s emphasis was on automatic thoughts,
- Ellis focused on sits irrational thoughts are triggered by external events.
- Ellis said we get depressed when experiencing negative events
- these trigger irrational beliefs.
-
- Events like failing an important test or ending a relationship might trigger irrational beliefs.
..
• B Beliefs
- Ellis identified a range of irrational beliefs.
- called the belief we must always succeed or achieve perfection ‘musterbation’.
» opposite of utopianism wch is belief life is always meant to be fair.
-
- Mustubatory thinking is centred on certain ideas/assumptions
- that must be true for an individual to be happy such as:
• I must be approved or accepted by people I find important
• I must do well or I am worthless
• The world must give me happiness, or I will die
One who holds such assumptions is bound to be disappointed;
at worst, depressed.
> one who fails an exam becomes depressed not bc they failed
> but bc they hold an irrational belief regarding that failure.
»_space; Such musts need to be challenged in order for mental healthiness to prevail.
..
• C Consequences
- when an activating event triggers irrational beliefs
- there are emotional and behavioural consequences.
> eg if you believe you must always succeed and then fail at smth
this can trigger depression
Whats the negative triad in detail
When depressed, negative thoughts of the world, future and oneself come to us.
a) Negative view of the world
- eg ‘the world is a cold hard place.’
- impression there’s no hope anywhere.
b) Negative view of the future
- eg ‘there isn’t much chance the economy will really get better’.
- reducing any hopefulness and enhance depression.
c) Negative view of the self
- eg ‘I am a failure.’
- enhance existing depressive feelings; confirm current emotions of low self-esteem.
EVALUATION of the cognitive approach to EXPLAINING depression
+ Support for role of irrational thinking
- The view depressions linked to irrational thinking is supported.
- Bates et al. found depressed ppts given negative automatic-thought statements
- became more and more depressed,
> supporting view that negative thinking leads to depression
-
— BUT, the fact theres a link between negative thoughts and depression
- doesnt mean they cause depression; may be opposite, that depression causes accepting negative thoughts
> incomplete study as doesnt investigate other way round
-
— just correlation
..
— doesn’t explain all aspects of depression
- Some depressed are deeply angry
- Beck and Ellis cannot explain this extreme emotion
- Some with depression suffer hallucinations/bizarre beliefs; cannot be explained by cognitive theories.
..
— Reductionist/Blames client not thinking of situational factors (just dispositional)
- may lead client/therapist to ignore situational factors
> eg life events at home may have contributed to depression
..
+ Practical applications in therapy
- been applied to CBT
- been found as best treatment esp in conjuction with drug treatments
Whats the cognitive approach to treating depression (CBT Becks cognitive therapy)
Cognitive behaviour therapy (CBT)
> begins with an assessment where the patient and therapist discuss
- to clarify patients problems.
- They jointly identify goals for therapy; make a plan to achieve them.
-
- One central task is to identify where there may be negative/irrational thoughts
that will benefit from challenge.
- CBT then involves changing thoughts and putting more effective behaviours in place.
- Some CBT therapists do this using techniques only from Beck’s cognitive therapy,
or exclusively on Ellis’s rational emotive behaviour therapy; Most draw on both.
..
СВТ: Beck’s cognitive therapy
Cognitive therapy is application of Beck’s negative triad theory of depression.
- The idea behind cognitive therapy is to identify
- automatic thoughts abt world, the self and the future - this is the negative triad.
- Once identified the thoughts are challenged; central component of therapy.
-
- With challenging the thoughts directly, cognitive therapy aims to help patients
- test reality of negative beliefs.
- so may be set hwk like to record when they enjoyed an event/when ppl were nice to them.
» referred to as ‘patient as scientist’
»_space; investigating reality of their negative beliefs in way a scientist would.
In future if patients says no one is nice to them or theres no point in going to events, - the therapist can show this evidence and use it to prove patient incorrect.
Whats the cognitive approach to treating depression (REBT)
СВТ: Ellis’s rational emotive behaviour therapy (REBT)
- extends the ABC model to an ABCDE model
- D stands for dispute
- E for effect.
The main technique of REBT is to identify and dispute/challenge irrational thoughts. > eg a patient may talk abt how unlucky theyve been/how unfair things seem.
- REBT therapist identifies the examples of utopianism (belief all shd be fair)
- and challenge this as an irrational belief.
- This wd involve a vigorous argument.
- The intended effect is to change irrational belief to so break link
- between negative life events/ depression.
This vigorous argument is the hallmark of REBT.
Ellis identified different methods of disputing.
1) empirical argument involves disputing whether theres actual evidence to support negative belief.
2) Logical argument involves disputing whether negative thought logically follows from facts.
•
•Behavioural activation
Alongside purely cognitive aspects of CBT > therapist may also work to encourage a depressed patient to be more active
> and engage in enjoyable activities.
This behavioural activation will provide more evidence for irrational nature of beliefs.
EVALUATION of the cognitive approach to TREATING depression
+ It is effective; research support
- lots of evidence to support effectiveness of CBT for depression.
> March et al. compared effects of CBT, antidepressant drugs, a combo of both in 327 adolescents with depression.
>
» After 36 weeks
81% of CBT group
81% of the antidepressant group
86% of CBT plus antidepressants group were significantly improved.
- so CBT emerged as effective as medication/helpful alongside medication.
..
— CBT may not work for most severe cases
- In some, depression can be so severe
patients cant motivate themselves
- to engage with hard cognitive work of CBT.
> may not even be able to pay attention to what happens in a session.
-
-Where this happens, its possible to treat patients with antidepressant medication
- start CBT when more alert/motivated
- so CBT cant always be the sole treatment for depression.
..
+ Support for behavioural activation
- Babyak et al. studied 156 adult volunteers with major depressive disorder. - were randomly assigned to
a four-month course of aerobic exercise,
drug treatment (an antidepressant drug)
or a combo of the two.
-
- Clients in the groups exhibited significant improvement after four months.
- Six months after end of study, those in exercise group had significantly lower relapse rates
- than those in medication group,
- particularly those whod continued with exercise regimes on their own.
Whats the biological approach to explaining OCD (neural explanations)
The emphasis of biological approach is on how physical elements or our body
- may be used to understand behaviour.
> includes genes wch are present in every cell of our body,
> providing instructions for physical and psychological characteristics.
>
> Biological explanations also concern brain and neurotransmitters (chemicals) in the brain.
..
Neural explanations
- genes associated with OCD are likely to affect lvls of key neurotransmitters (chemicals in brain)
- as well as structures of the brain.
These are neural explanations.
• The role of serotonin
- One explanation for OCD concerns role of neurotransmitter serotonin,
- wch helps regulate mood.
- Neurotransmitters are responsible for relaying info from one neuron to another.
-
- If one has low lvls of serotonin then normal transmission of mood-relevant info does not take place
- and mood and sometimes other mental processes are affected.
- some cases of OCD may be explained by reduction in functioning of serotonin system in brain.
• Decision-making systems
- Some OCD cases, in particular hoarding disorder,
- seem to be associated with impaired decision making.
> This may be associated with abnormal functioning of lateral (side bits) of the frontal lobe of the brain.
> The frontal lobe (front part of brain) is responsible for logical thinking/ decisions.
-
- Theres evidence to suggest an area called the parahippocampal gyrus,
- associated with processing unpleasant emotions, functions abnormally in OCD
diagram 2
Whats the second biological approach to explaining OCD (genetic explanations)
Genefic explanations
- We inherit 23 pairs of chromosomes from parents.
- Genes make-up chromosomes and consist of DNA
- codes for physical features of an organism (such as eye colour, height)
- and psychological features (such as mental disorder, intelligence).
• Genes are involved in individual vulnerability to OCD.
Lewis (1936) observed of his OCD patients
37% had parents with OCD
21% had siblings with OCD.
suggests OCD runs in families, although whats passed through gens is
- genetic vulnerability not OCD certainty
-
According to the diathesis-stress model
- certain genes leave some ppl more likely to suffer a mental disorder
- but is not certain - some environmental stress (experience)
- is necessary to trigger the condition.
..
• Candidate genes
Researchers identified genes, wch create vulnerability for OCD, candidate genes.
> Some of these are involved in regulating development of serotonin system.
> Eg, the SERT gene (also called 5-HTT)
> wch affects transport of serotonin,
creating lower levels of neurotransmitter.
- One study found a mutation of the gene in two unrelated families
- where 6/7 family members had OCD (Ozaki et al., 2003).
..
• OCD is polygenic
means OCD is not caused by one single gene but several genes are involved.
- Taylor (2013)analysed findings of previous studies
- found evidence up to 230 diff genes may be involved in OCD.
-
- Genes studied in relation to OCD include those associated
- with action of dopamine and serotonin,
- both neurotransmitters believed to have a role in regulating mood.
..
• Different types of OCD
- One group of genes may cause OCD in one person
- but a diffgroup of genes may cause in another person.
- The term used to describe this is aetiologically heterogeneous,
»_space; meaning the origin (aetiology) of OCD has diff causes (heterogeneous).
-
There is also some evidence to suggest
- diff types of OCD may be result of particular genetic variations,
- such as hoarding disorder and religious obsession.
EVALUATION of the biological approach to EXPLAINING OCD
• supporting evidence
evidence supporting neural mechanisms in OCD.
- eg some antidepressants work purely on the serotonin system, increasing its levels
- are effective reducing OCD symptoms
- suggests serotonin system’s involved in OCD.
-
- is also evidence of vulnerability to OCD due to genetic make-up.
- Nestadt et al. (2010) reviewed previous twin studies and found that
68% of identical twins shared OCD
And 31% of non-identical twins
..
• not clear exactly what neural mechanisms are involved
- Studies of decision making show these neural systems are
- the same systems that function abnormally in OCD.
> BUT, research has identified other brain systems that may be involved
»_space; but no system has been found that ALWAYS plays a role in OCD.
..
• Too many candidate genes
Although twin studies strongly suggest OCD is largely under genetic control,
- psychologists are much less successful at pinning down all involved genes.
> One reason is because it appears that several genes are involved
> and each genetic variation only increases risk of OCD by a fraction.
..
• Environmental risk factors
- seems environmental factors can also trigger or increase risk of developing OCD
> (the diathesis-stress model).
-
- Cromer et al. (2007) found over half OCD patients in sample had a traumatic event
- and that OCD was more severe in those with more than one trauma.
> may be more productive to focus on environmental causes
> because we are more able to do something about these.
Whats the biological approach to TREATING OCD (drug therapy)
Drug therapy for mental disorders
- aims to increase/decrease levels of neurotransmitters in brain
- or to increase/decrease patient’s anxiety.
- We’ve seen low levels of serotonin are associated with OCD.
- So drugs work in many ways to increase level of serotonin in the brain.
..
• SSRIs
The standard medical treatment used involves an antidepressant drug
> called a selective serotonin reuptake inhibitor (or SSRI).
-
- SSRIs work on serotonin system in brain.
- Serotonins released by certain neurons in brain (presynaptic neurons) and travels across synapse gap
- neurotransmitter chemically passes signal from presynaptic neuron
- to postsynaptic neuron and then its reabsorbed by presynaptic neuron
- where its broken down and reused.
-
SSRIs prevent this reabsorption/reuptake, > so enable serotonin to stat active at synaptic cleft,
> where it continues to stimulate post synaptic neuron.
Where SSRI isnt effective after 3/4 months
-the dose can be increased (e.g. to 60mg a day for Fluoxetine - a brand of SSRI)
-or is combined with other drugs. -Sometimes diff antidepressants/drugs are tried.
What are two types of antidepressants ? In treating OCD
• Tricyclics (older type of antidepressant) are used, eg Clomipramine.
- have the same effect on serotonin system as SSRIs.
- Tricyclics block transporter mechanism tht reabsorbs serotonin and noradrenaline
- in pre-synaptic cell after it has fired.
- As a result more neurotransmitters are left in synapse,
- prolonging activity, and easing transmission of next impulse.
+ Tricyclics have advantage of targeting more than one neurotransmitter.
—However, have more severe side-effects than SSRIs
so is generally kept in reserve for patients who dont respond to SSRIs.
..
• Anti-anxiety drugs (Benzodiazepines (BZs))
- are commonly used to reduce anxiety.
- BZs slow down activity of CNS by enhancing activity
- of neurotransmitter GABA; when released has a general quietening effect
- on many neurons in brain.
-
- does this by reacting with special sites (GABA receptors)
- on outside of receiving neurons.
- When GABA locks into these receptors
- it opens a channel that increases flow of chloride ions into neuron.
> Cl ions make harder for neurons to be stimulated by other neurotransmitters,
> thus slowing its activity and making the person feel more relaxed
EVALUATION of the biological approach to TREATING OCD
+ research support shows its effective
Theres evidence for effectiveness of SSRIs in reducing severity of OCD symptoms
> so improving quality of life for patients.
-
- Soomro et al. reviewed studies comparing SSRIs to placebos
- in OCD treatment of and concluded all 17 studies showed significantly better results - for SSRIs than for placebo conditions.
- Effectiveness is best when SSRIs are combo w psychological treatment, eg CBT.
-
Typically OCD symptoms decline for abt 70% patients taking SSRIs.
> Of the 30%, alternative drug treatments or combos of drugs/psychological treatments will be effective for some.
..
+ Drugs are cost-effective and non-disruptive
- Drug treatments are cheap compared to psychological treatments,
- so good value for public health system like NHS.
-
- As compared to psychological therapies, SSRIs are non-disruptive to patients’ lives.
- you can simply take drugs til symptoms decline and not engage with hard work of psychological therapy.
..
— Drugs can have side-effects
- A minority of sufferers will not benefit from drug therapy.
- Some patients suffer side-effects like indigestion,blurred vision,loss of sex drive.
> These side-effects are usually temporary.
-
- For those taking Tricyclics, side-effects are more common; can be more serious.
- abt 1/10 patients suffer erection problems, tremors, weight gain.
- abt 1/100 get aggressive, suffer disruption w blood pressure, heart rhythm
> Such factors reduce effectiveness as ppl stop taking medication.
