psychopathology 2 Flashcards
what is depression?
a mood disorder that results in low mood
what are behavioural symptoms?
they refer to the way people act
what are the behavioural symptoms of depression?
-reduction in energy
-constantly feeling tired
-disturbed sleep pattern
-change in appetite
-changes in activity (eg: social withdrawal)
what are emotional symptoms?
refer to the way people feel
what are the emotional characteristics of depression?
-low mood
-feelings of worthlessness
-lack of interest / pleasure in everyday activities
-anger and irritability
-guilt
what are cognitive symptoms?
refer to the way people think /process information
what are the cognitive symptoms of depression?
-diminished ability to concentrate
-tendency to focus on the negative
-negative thoughts
Ahead are some case studies of depression. For each one, list any behavioural, emotional and cognitive symptoms.
Kristen is a 38 year-old divorced mother of two teenagers. She has had a successful, highly paid career for the past several years in upper-level management. Even though she has worked for the same, thriving company for over 6 years, she’s found herself worrying constantly about losing her job and being unable to provide for her children. This worry has been troubling her for the past 8 months. Despite her best efforts, she hasn’t been able to shake the negative thoughts.
Ever since the worry started, Kristen has found herself feeling restless, tired, and tense. She often paces in her office when she’s there alone. She’s had several embarrassing moments in meetings where she has lost track of what she was trying to say. When she goes to bed at night, it’s as if her brain won’t shut off. She finds herself mentally rehearsing all the worst-case scenarios regarding losing her job, including ending up homeless.
behavioural symptoms:
paces in her office when she’s there alone loses track of what she’s saying
emotional symptoms:
feeling restless, tired and tense
cognitive symptoms:
worrying constantly about losing her job and being unable to provide for her children, negative thoughts
Josh is a 27 year-old male who moved back in with his parents after his fiancée was killed three months ago by a drunk driver mounting the pavement when they were walking together. No matter how hard he tries to forget, he frequently finds himself reliving the entire incident as if it was happening all over. He is angry not only with the driver but with the world - he feels he had everything and now it’s all been taken away through no fault of his.
Since the accident, Josh has been plagued with nightmares about it almost every night. He had to quit his job because his office was located in the building right next to the little café where he and his fiancée used to meet for lunch. He has since avoided that entire area of town. Normally an outgoing, fun-loving guy. Josh has become increasingly withdrawn, jumpy and irritable since his fiancées death. He’s stopped working out, playing his guitar, or playing basketball with his friends - all activities he once really enjoyed. His parents worry about how detached and emotionally flat he’s become.
behavioural symptoms:
-he avoids the little cafe where he and his fiancé meet for lunch
-he quit his job
emotional symptoms:
he is angry with the driver and the world
cognitive symptoms:
he feels he had everything and now it’s been taken away
how is depression explained?
through the cognitive approach
what does the cognitive approach believe about depression?
-emotional problems are the result of cognitive distortions (irrational thinking)
-the focus is not on the problem itself but the way a person thinks about it
how is depression explained through the cognitive approach?
there are the two key cognitive theories which attempt to explain depression:
-beck’s cognitive triad
-ellis’s irrational thinking (ABC Model)
assumptions of the cognitive approaches explanation of mental disorders:
-individuals who suffer from mental disorders have distorted and irrational
thinking – which may cause maladaptive behaviour
-it is the way you think about the problem rather than the problem itself
which causes the mental disorder
-the cognitive approach focuses on an individual’s negative thoughts,
irrational beliefs and misinterpretation of events as being the cause of
depression
-individuals can overcome mental disorders by learning to use more
appropriate cognitions. if people think in more positive ways, they can be
helped to feel better
what did beck believe that depression was caused by?
-negative self‐schemas that maintain the negative triad
-beck suggested that there is a cognitive explanation as to why some people are more vulnerable to depression than others
parts of cognitive vulnerability:
-faulty information processing
(cognitive bias)
-negative self-schemas
-the negative triad
what is cognitive bias?
-beck believed that depressed peoppe are more likely to focus on the negative
aspects of a situation, while ignoring the positives
-they distort and misinterpret
information
↳ this process is called cognitive bias
examples of cognitive bias:
-overgeneralising
-catastrophising
-all or nothing thinking
what is overgeneralising?
where someone may make a sweeping conclusion based on a single incident
what is catastrophising?
where they exaggerate a minor setback and believe that it is a complete disaster
what is all or nothing thinking?
a tendency to think in concrete, black and white terms
what is a negative self schema?
according to beck, depressed people possess negative self‐schemas, which may come from negative experiences → they interpret all the information about themselves in a negative way
examples of negative schemas in those with depression:
self-blame schema - makes people with depression feel responsible for mistakes/misfortune
ineptness schema - makes people with depression expect to fail
study that relates to negative schemas:
weissman and beck (1978)
(BDI - beck’s depression inventory)
aim: weissman and beck study
to investigate the thought processes of depressed people to establish if
they use of negative schemas
method: weissman and beck study
-thought processes were measured using the Dysfunctional Attitude
Scale (DAS)
-participants were asked to fill in a questionnaire by ticking whether
they agreed or disagreed with a set of statements (for example, ‘people will
probably think less of me if I make a mistake’)
results: weissman and beck study
-they found that depressed participants made more negative assessments than non-depressed people
-when given some therapy to challenge
and change their negative schemas there was an improvement in their self-
ratings
conclusion: weissman and beck study
depression involves the use of negative schemas
what is the negative triad?
beck suggested that people with depression become trapped in a cycle of negative thoughts - they have a tendency to view themselves, the world and the future in pessimistic ways
what does the negative triad include?
1) negative views of the world
2) negative views of the future
3) negative views of the self
what does each part of the negative triad lead to?
negative view of the world → no hope
negative view of the future → no
hope for change and no point in trying
negative view of the self → low self
esteem, leads to someone “giving up”
Outline at least two ways in which a cognitive psychologist might explain depression in a person who has recently
become unemployed. (4 marks)
1) cognitive/negative triad - person will have negative thoughts about self, world, future eg I’m useless, the
world is horrid, I’ll never get a job
2) the person will have cognitive bias
➢ the person may overgeneralise ‘no-one wants me’
➢ person may magnify catastrophise eg loss of job will be seen as major disaster
what does ellis’s believe issues like depression are caused by?
-ellis proposed that good mental
health is the result rational thinking
defined as thinking → allow people to be happy and free of pain
-to ellis, conditions like anxiety and depression (poor mental health) result from irrational thinking
ellis’s definition of irrational thoughts:
thoughts that interfere with us being happy and free of pain
what is the ABC model?
a three stage model to explain how irrational thoughts affect our behaviour and emotional state (lead to depression)
what are the three stages of the ABC model?
1) activating event
2) beliefs
3) consequences
A - activating event
the negative event experienced that triggers irrational beliefs
(for example, you pass your friends in the corridor at school and he/she ignores you, despite the fact the said ‘hello’)
B - belief
your belief is your interpretation of the event (could be rational or irrational)
(for example:
➢ a rational interpretation of the event might be that your friend is very busy
and possibly stressed, and he/she simply didn’t see or hear you
➢ an irrational interpretation of the event might be that your friend dislikes you and never wants to talk to you again)
C - consequence
when an activating event triggers irrational beliefs, there are emotional and behavioural consequences
irrational beliefs can lead to unhealthy emotions and behaviours, including depression
→ eg: I will ignore my friend and delete their mobile number, as they clearly don’t want to talk to me
rational beliefs lead to healthy emotional outcomes (for example, ‘I will talk to my friend later and see if he/she is okay’)
strengths of the cognitive explanation of depression:
-there is research evidence which supports the cognitive explanation of depression
-it has real-world application in the psychological treatment of depression.
ao3 / strength - there is research evidence which supports the cognitive explanation of depression
P - there is research evidence which supports the cognitive explanation of depression
E - beck measured thought processes using the Dysfunctional Attitude Scale (DAS) where participants had to agree or disagree with a set of statements
(for example, ‘people will probably think less of me if I make a mistake)
↳ they found that depressed participants made more negative assessments than non-depressed people
↳ when given some therapy to challenge and change their negative schemas there was an improvement in their self-rating
L - these findings support different components of Beck’s theory and the idea that negative thinking is involved in depression
ao3 / strength - it has real-world applications in the psychological treatment of depression
P - beck and ellis’s model has real-world applications in the psychological treatment of depression
E - beck’s model allows psychologists to screen for cognitive vulnerability in young people, identify those most at risk of depression in the future and monitor them
↳ therapies like cognitive behavioural therapy (CBT) let clients to change the cognitions that make people vulnerable to depression
E - likewise, ellis’ model has had contributions to cognitive therapy - rational emotive behavioural therapy (REBT)
↳ the aim is to alter the irrational beliefs that are making them unhappy
L - therefore suggesting that if we can successfully treat patients’ depressive thoughts, the origins of depression must lie in faulty/irrational thinking
criticisms of the cognitive explanation of depression:
-it is difficult to differentiate whether thoughts are the cause or consequence of depression
ao3 / criticism - it is difficult to differentiate whether thoughts are the cause or consequence of depression
P - it is difficult to differentiate whether thoughts are the cause or consequence of depression
E - it’s not clear what comes first, if the thoughts and beliefs that cause depression or if depression leads to faulty thinking
↳ it may be that a depressed individual develops a negative way of thinking because of their depression rather than the other way around
L - therefore, we cannot be certain that faulty cognitions precede depression
↳ consequently, it is possible that other factors, for example genes and neurotransmitters, are the cause of depression and the negative, irrational thoughts are the symptom of depression
what are the cognitive treatments of depression based on?
the assumption that faulty thinking makes a person vulnerable to
depression
what is CBT?
a psychological treatment for depression and other mental health problems
(it involves cognitive and behavioural elements)
what is the cognitive element of CBT?
it aims to identify irrational and negative thoughts, which lead to depression & replace these negative thoughts
with more positive and rational ones
what is the behavioural element of CBT?
encourages patients to test their beliefs
through behavioural experiments and homework
what does CBT involve?
-between 5 and 20, weekly, or
fortnightly sessions
-each session will last between 30 and 60 minutes
overview of CBT:
-CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the client’s problems
-they jointly identify goals for the therapy and put together a plan to achieve them
-one of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge
what are the components of CBT?
- initial assessment
- goal setting
- identify negative/irrational thoughts and challenge these
a. beck’s cognitive therapy
OR
b. ellis’s REBT
- homework
strategies used in CBT for depression:
-challenging irrational thoughts
-the client as scientist/reality testing
-dairy records
-education phase
challenging irrational thoughts
requires the client to gather evidence of behaviours/incidents and then compare the evidence with the thought expressed to check whether they match or not
the client as scientist/reality testing:
-homework assignments where the client’s hypothesis/negative thinking is tested and the evidence evaluated (hypothesis testing)
-e.g. if the person believes they are incapable of being included in conversations, they may be asked to talk to strangers in a social situation
-therapists would only set tasks they are confident the patient can succeed at so as not to reinforce ineptness schemas
diary records
to monitor events and identify situations in which negative thinking (thought catching) occurs so these can be targeted
education phase
individuals learn the relationship between thoughts, emotions and behaviour
beck’s cognitive behavioural therapy:
-a therapist is using beck’s cognitive therapy will help the patient to identify negative thoughts in relation to themselves, their world and their future, (using Beck’s negative triad)

-the patient and therapist will work
together to challenge these irrational thoughts by discussing evidence for and against them
-the patient will be encouraged to test the validity of their negative thoughts and may be set homework, to challenge and test their negative thoughts
ellis’s cognitive behavioural therapy:
rational emotive behaviour therapy (REBT)
-REBT involves a person reframing and challenging negative thoughts in relation to themselves, their world, thoughts by reinterpreting to ABC in a more positive, logical way
-ellis developed his ABC model to include D (dispute) and E (effective)
-the main idea is to challenge irrational thoughts; with ellis’s theory, this is achieved through ‘dispute’ (argument).
↳ this replaces their irrational beliefs with more effective beliefs and attitudes
strength of CBT:
-there is a large body of evidence supporting its effectiveness for treating depression
ao3 / strength - there is a large body of evidence supporting CBTs effectiveness for treating depression
P - there is a large body of evidence supporting CBTs effectiveness for treating depression
E - march (2007) compared the effects of CBT with antidepressants and also a combination of the two in 327 adolescents with main diagnosis of depression
↳ 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressant group were significantly improved
↳ CBT was effective at treating depression when used on its own and more so when used alongside antidepressants
↳ CBT is usually a fairly brief therapy requiring 6-12 sessions, so it is also cost-effective
L - this shows the effectiveness of CBT in treating depression and means that CBT is widely seen as the first choice of treatment in public health care systems such as the NHS
criticisms of CBT:
-high relapse rate
-not suitable for all clients
ao3 / criticism of CBT - high relapse rate
P - a limitation of CBT for the treatment of depression is its high relapse rates
E- although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last
↳ relatively few early studies of CBT for depression looked at long-term effectiveness
↳ some more recent studies suggest that long-term outcomes are not as good as had been assumed
↳ ali (2017) assessed depression in 439 clients every month for a year following a course of CBT → 42% of the clients relapsed into depression within six months of ending treatment and 53% relapsed within a year
L - this means that CBT may need to be repeated periodically
ao3 / criticism of CBT - not suitable for all clients
P - one issue with CBT is that it requires motivation
E - patients with severe depression may not engage with CBT or even attend the sessions and therefore this treatment will be ineffective in treating these patients
↳ alternative treatments, such as antidepressants, do not require the same level of motivation and may be more effective in these cases
L - this poses a problem for CBT, as CBT usually cannot be used as the sole treatment for severely depressed patients, who often lack the motivation to attend therapy and to speak about their depression
what is OCD?
an anxiety disorder with two main components (obsessions and
compulsions)
distributions of obsessions and compulsions:
the majority of OCD sufferers experience combined obsessions and compulsions, however, some experience just obsessions and some experience
just compulsions
what is an obsession?
a thought, idea, impulse or image that is experienced repeatedly, feels intrusive and causes anxiety
what is a compulsion?
a repetitive and rigid behaviour or mental act that a person feels driven to perform in order to prevent or reduce
anxiety
behavioural symptoms of OCD:
compulsions:
these are repetitive in nature and are used to manage or reduce anxiety
emotional symptoms of OCD:
-anxiety caused by obsessions
-depression - the anxiety experienced can result in low mood and loss of pleasure in everyday activities because everyday tasks are being interrupted by obsessive thoughts and repetitive compulsions
cognitive symptoms of OCD:
recurrent obsessive thoughts
obsessions are persistent and/or forbidden thoughts, which cause high
levels of anxiety in OCD sufferers
selective attention
directed towards the anxiety‐generating
stimuli
what is the OCD cycle?
obsessive/intrusive thought → increases anxiety → compulsion (behaviour) → reduces anxiety
Ahead are some case studies about OCD
For each one, list any behavioural, emotional and cognitive symptoms
Mark is 25 years old and, despite having OCD since he was a child, managed to graduate as an engineer and obtain a responsible job. Sadly, the OCD prevented him coping with such responsibility and he is now back living with his parents and unemployed.
Mark’s basic fear is of making a mistake. As a child he checked his homework excessively. He has a history of obsessional ruminations. Ruminations usually involve worrying in case he has made a mistake in the course of performing some quite trivial action. Anxiety and doubt can result from very ordinary everyday activities such as turning on a light, changing direction while walking or going
from one room to another. The degree of doubt felt is so strong that at times, when switching on a light, he would not trust his perception and, wondering if he had made a mistake, he would attempt to trace the wiring behind the wall in order to try to follow where the current went back to the switch, thus convincing himself that the bulb was actually lit. Eventually he went for treatment. By this time he was thinking of hypothetical
behavioural symptoms
checked his homework excessively, traces the wiring behind the wall to try and follow where the current goes back
emotional symptoms
anxiety and doubt from everyday activities (eg: turning on a light)
cognitive symptoms
worrying in case he made a mistake while doing a trivial action (rumination)
Louise is in her mid-forties and is obsessed with a fear of contamination. According to her, she is afraid of nearly everything but is particularly anxious about touching wood, canned goods and any shiny objects, such as silverware or even the silver embossing on greetings cards.
In order to control her fear she engages in compulsive rituals which take up all of her waking hours. In the morning she spends 3-4 hours in the bathroom washing and rewashing herself. Between baths she scrapes away the outer layer of the soap so it is free of germs. Mealtimes last for hours. Louise eats 3 bites at a time and chews each
mouthful 300 times. These steps are believed to magically decontaminate the food. Her husband is sometimes dragged reluctantly into these rituals, shaking a kettle or frozen vegetables over her head to remove the germs.
Louise’s rituals and fear of contamination have reduced her life to doing almost nothing else. She does not leave the house, do housework or even talk on the phone. (Adapted from Davison and Neale)
behavioural symptoms
scrapes the outer layer of soap away so it is free of germs (compulsive rituals)
emotional symptoms
anxiety from touching wood, canned goods & shiny objects
cognitive symptoms
thinks that chewing each mouthful 300 times will decontaminate the food (obsession about contaminatin)
what are the 2 parts to the biological explanation of OCD?
-genetic
-neural (neurotransmitters and brain structures)
what is the genetic explanation for OC?
-it proposes that there is a genetic component to OCD which predisposes some individuals to the illness
-genetic explanations suggest that OCD is inherited and that individuals receive specific genes from their parents
which influence the onset of OCD
OCD is believed to be…
a polygenic condition, this means that several genes are involved in its inheritance
evidence for the genetic basis of OCD:
taylor (2003) suggests that as many as 230 genes may be involved in the condition and perhaps different genetic
variations contribute to the different types of OCD
↳ two examples of genes that have been linked to OCD are the COMT gene and SERT gene
different types of OCD & genetics
different types of OCD may be caused by different groups pf genes in different people → the term used to describe this is aetiologically heterogeneous
aetiologically heterogeneous
meaning that the origin (aetiology) of OCD has different causes (heterogeneous)
the COMT gene:
-it’s associated with the production of an enzyme COMT, which regulates and breaks down the neurotransmitter dopamine
-it stops the synapse from getting clogged up with dopamine
-in patients with OCD, their COMT gene is faulty → the enzyme isn’t produced → it doesn’t break down dopamine → results in higher levels of dopamine, compared to people without OCD
the SERT gene:
-it affects the transport of serotonin (hence SERotonin Transporter)
-OCD patients have been found to have mutations in the SERT gene → causes transportation issues → causes lower levels of serotonin to be active within the brain
-ozaki (2003) published results from a study of two unrelated families who both had mutations of the SERT gene
-It coincided with six out of seven of the family members having OCD
genetic support: family/twin studies
nestadt et al (2000)
-80 patients with OCD & 343 of their near relatives were compared to a control group without mental illness &
their relatives
-5x greater risk if had first degree relative
nestadt et al. (2010)
reviewed twin studies and found 68% of MZ (identical) twins shared OCD as opposed to 31% of DZ (non-identical twins)
strengths of the biological explanation of OCD:
-the biological explanation of OCD comes from research support seen in family studies
ao3 / strength - the biological explanation of OCD comes from research support seen in family studies
P - the biological explanation of OCD comes from research support seen in family studies
E - nestadt et al. (2000) proposes that individuals who have a first-degree relative with OCD are up to five times more likely to develop the disorder over their lifetime compared to members of the general population
↳ nestadt et al. (2010) reviewed twin studies and found 68% of MZ (identical) twins shared OCD as opposed to 31% of DZ (non-identical twins)
L - research from family studies like this provides support for a genetic explanation for OCD, although it does not rule out other (environmental) factors playing a role.
criticisms of the biological explanation of OCD:
-individuals may gain a vulnerability towards OCD through genes that is then triggered by an environmental stressor
-twin studies suggest that nurture has an influence on the development of OCD
ao3 / strength - individuals may gain a vulnerability towards OCD through genes that is then triggered by an environmental stressor
P - individuals may gain a vulnerability towards OCD through genes that is then triggered by an environmental stressor
E - environmental factors can also trigger the risk of developing OCD
↳ for example, cromer (2007) found that half of the OCD patients in their sample had a traumatic event in their past, and that OCD was more severe with those with more than one trauma
↳ the diathesis-stress model states that certain genes biologically predispose (diathesis) someone to OCD but needs an environmentally ‘stressor to trigger the condition
L - this means that it may more productive to focus on environmental causes as it seems that not all OCD is entirely genetic in origin
ao3 / strength - twin studies suggest that nurture has an influence on the development of OCD
P - twin studies suggest that nurture has an influence on the development of OCD
E - OCD could be caused by nurture rather than nature, identical twins’ concordance rate would likely be higher if OCD had a clear cut genetic origin as identical twins have the same environment, even in the womb
L - therefore OCD is likely affected by nurture
neural explanations of OCD:
the genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain → these are neural explanations
examples of neural explanations:
-abnormal levels of certain neurotransmitters
-certain brain circuits may be abnormal
issues with which two neurotransmitters cause OCD?
serotonin – lower levels of serotonin found in OCD sufferers
dopamine levels are high in
people with OCD, thought to be associated with compulsive behaviours
serotonin’s role in OCD:
-when neurotransmitters are chemically fired across the synaptic gap, the
neurotransmitter is re-absorbed back into the pre-synaptic neuron so it can be used again, or enzymes break down any neurotransmitter left in the synapse
-for OCD sufferers, the reuptake transporter is working more than normal which means more serotonin is re-absorbed back into the pre-synaptic
neurone too soon before it reaches the post-synaptic neurone
-this means that less serotonin is available in the synapse and is less likely to be taken up by the receptors of the post-synaptic neuron
-therefore there are low levels of serotonin in the brain
what effect does reduced serotonin have?
lower mood / anxiety (overactivity in some brain areas) → leads to
increased antrely
evidence for the role of serotonin in OCD:
piggott et al. (1990)
found that drugs which increase the
level of serotonin in the synaptic gap are
effective in treating patients with OCD
(SSRIs)
what effect do higher levels of dopamine have?
dopamine is associated with compulsions
which three brain regions are implicated specifically in OCD? (neural explanations)
-basal ganglia
-orbitofrontal cortex
-thalamus
what is the basal ganglia?
a cluster of neurones at the base of the forebrain that are responsible for
many processes, but mainly innate psychomotor functions
role of the basal ganglia in OCD:
it is thought that the basal ganglia are hypersensitive which can lead to abnormal control of behaviours
↳ this is thought to cause the
compulsions seen in OCD
evidence for the role of the basal ganglia in OCD:
Max et al. (1994)
found that when the basal ganglia is
disconnected from the frontal cortex during surgery, OCD-like symptoms are reduced, providing further support for the role of the basal ganglia in OCD
(+patients who suffer head injuries in this region often develop OCD‐like symptoms)
what is the role of the thalamus?
a brain with functions including cleaning, checking and other safety behaviours
what is the role of the OFC?
the OFC is involved in decision making and worry about social and other behaviour
the role of the OFC and thalamus in OCD.
the thalamus and OFC are linked
↳ in OCD the thalamus is thought to be overactive, which causes the OFC to become overactive
what does an overactive thymus lead to?
an increased motivation to clean or check for safety
what does an overactive OFC lead to?
increased anxiety and increased planning to avoid anxiety (increased compulsions)
evidence of the role of the OFC in OCD:
PET scans have found higher activity in the orbitofrontal cortex in patients with OCD when, for example, a patient is asked to hold a dirty item with a potential germ hazard
what is the caudate nucleus?
in a normal brain this controls the worry
circuit between the thalamus and the OFC & stops our worry
strengths & weaknesses of the neural explanations of OCD:
strengths:
real world applications
weaknesses:
-the biological explanations of OCD can be criticised for being reductionist
ao3 / strength of the neural explanation of OCD - real world applications
P - a strength of the neural explanation of OCD is that there are real world applications
E - knowing that serotonin is implicated in the illness has led to development of SSRI medication that works to increase
serotonin levels in some areas of the brain
↳ these drugs are successful in treating symptoms of those with OCD
L - this shows that the biological explanation has practical applications that can bring relief from suffering and have been useful to society
ao3 / weakness of the neural explanations of OCD - the explanation can be criticised for being reductionist
P - the biological explanations of OCD can be criticised for being reductionist
