Psychopathology

Question 1

Describe and evaluate ‘statistical deviation’ as a definition of abnormality.

Answer 1

A01

The most obvious way to define something as ‘normal’ or ‘abnormal’ is according to the number of times we observe it.
Example: IQ and intellectual disability disorder
Normal distribution: the majority of people’s scores will cluster around the average.
The further we go above or below the average the fewer people will attain that score.
Those people scoring below 70 IQ are very unusual and are liable to receive a diagnosis of a psychological disorder.

A02

Unusual characteristics can be positive:

We wouldn’t think of super-intelligence as an undesirable characteristic that needs treatment.
Just because very few people display certain behaviours does make the behaviour statistically abnormal but doesn’t mean it requires treatment to return to normal.
Limitation: means it cannot be used as a sole explanation for a diagnosis.

Not everyone unusual benefits from a label:

If someone is living a happy and fulfilled life, there is no benefit to them receiving a label.
They may perceive themselves differently and others may look at them differently as well.

Question 2

Describe and evaluate ‘deviation from social norms’ as a definition of abnormality.

Answer 2

A01

When someone behaves in a way that is different from how we expect people to behave.
Norms are specific to the culture we live in
There are relatively few behaviours that would be considered universally abnormal on the basis that they breach social norms.
Example: antisocial personality disorder
Impulsive, aggressive and irresponsible.
An absence of prosocial internal standards associated with failure to conform to lawful or culturally ethical behaviour.
A psychopath is abnormal because they don’t conform to our moral standards.

A02

Not a sole explanation:

Strength: It has real life applications to diagnosing antiscoal personality disorder.
However, there are other factors to consider. For example, the distress to other people resulting from antisocial personality disorder.
Deviation from social norms is never the sole reason for defining abnormality.

Cultural relativism:

Social norms vary tremendously from one generation to another and from one culture to another.
Someone might label a behaviour as abnormal according to their standards rather than the standards of the person behaving that way.
Hearing voices.
Creates problems for people from one culture living within another culture group.

Question 3

Describe and evaluate ‘failure to function adequately’ as a definition of abnormality.

Answer 3

A01

When they are unable to maintain basic standards of nutrition and hygiene, cannot hold down a job or maintain relationships.
When is someone failing to function adequately?
- When a person no longer conforms to standard interpersonal rules
- When a person experiences severe personal distress.
- When a person’s behaviour becomes irrational or dangerous to themselves or others.
Example: intellectual disability disorder
A diagnosis of this would not be made on only the basis of statistical deviation - an individual must also be failing to function adequately.

A02

Patient’s perspective:

It attempts to include the subjective experience of the individual.
May not be entirely satisfactory because it is difficult to assess distress, but at least it acknowledges that the experience of the patient is important.
Strength: Useful criterion for assessing abnormality.

Is it simply deviation from social norms?:

Hard to differentiate between the 2
What do we say about people with alternative lifestyles who chose to not have a job or a permanent address?
Those who practice extreme sports could be accused of acting in a maladaptive way.
If we diagnose these as abnormal, we risk limiting personal freedom and discriminating against minority groups.
However, it is not that easy to be diagnosed as there are more criterion and you need to fit into all of them.

Question 4

Describe and evaluate ‘deviation from ideal mental health’ as a definition of abnormality.

Answer 4

A01

Once we have a picture of how we should be psychologically healthy then we can begin to identify who deviates from this ideal.
What does ideal mental health look like?
-we are rational and can perceive ourselves accurately
-We self-actualise and have motivation towards improvement
- We have strategies to 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 and enjoy our time
There is some overlap between failure to function adequately

A02

Cultural relativism:

Some of the classifications are specific to Western European and North American cultures - culture bound
The emphasis on personal achievement could be seen as self-indulgent in many cultures because the emphasis is on the individual rather than the community or family.
Much of the world would see being independent from other people as a bad thing.
It sets unrealistically high standard for mental health

Very few of us attain all of Jahoda’s criteria for mental health:

Therefore, this approach would see pretty much all of us as abnormal.
On the positive side - makes it clear to people the ways in which they could benefit from seeking treatment to improve mental health.
On the negative side - deviation from mental health is probably of no value in thinking about who might benefit from treatment against their will.

Question 5

Outline the behavioural characteristics of phobias.

Answer 5

Panic -
crying, screaming or running away.
Children may have temper tantrums.
Avoidance -
The sufferer tends to go to a lot of effort to avoid the phobic stimulus. This promotes negative reinforcement.
Endurance -
The sufferer remains in the presence of the phobic stimulus but continues to experience high levels of anxiety.

Question 6

Outline the emotional characteristics of phobias.

Answer 6

Anxiety -
An unpleasant state of arousal
Prevents the sufferer from relaxing and makes it difficult for them to experience any positive emotion.
Anxiety can be long term
These emotional responses are unreasonable
They are wildly disproportionate to the danger posed.

Question 7

Outline the cognitive characteristics of phobias.

Answer 7

Selective attention to the phobic stimulus -
Keeping out attention on something really dangerous is a good thing as it gives us the best chance of reacting quickly to a threat.
Irrational beliefs
Cognitive distortions - `

Question 8

Outline the behavioural characteristics of depression.

Answer 8

Activity levels -
Have a reduced activity level, making them lethargic.
Has a knock-on-effect on work and social life
In some cases they may be agitated and have a higher activity level.
Disruption to sleep and eating behaviour
Aggression and self-harm

Question 9

Outline the emotional characteristics of depression.

Answer 9

Lowered mood
Anger
Lowered self-esteem

Question 10

Outline the cognitive characteristics of depression.

Answer 10

Poor concentration
Attending to or dwelling on the negative
Absolutist thinking

Question 11

Outline behavioural characteristics of OCD

Answer 11

Compulsions -
Compulsions are repetitive
Compulsions reduce anxiety
Avoidance
They attempt to reduce their anxiety by keeping away from situations that might trigger it
The avoidance can lead people to avoid very ordinary situations and this can itself interfere with leading a normal life.

Question 12

Outline the emotional characteristics of OCD.

Answer 12

Anxiety and distress
Accompanying depression
Guilt and disgust

Question 13

Outline the cognitive characteristics of OCD.

Answer 13

Obsessive thoughts
Cognitive strategies to deal with obsessions
Insight into excessive anxiety

Question 14

Describe and explain the behavioural approach to explaining phobias.

Answer 14

A01

The two-process model:

The behavioural approach emphasises the role of learning in the acquisition of behaviour.
Explains the behavioural aspects of phobias

Acquisition by classical conditioning:

Learning to associate something of which we initially have no fear of, NS, with something that already triggers a fear response.
Explain UCR, UCS, NS, CR and CS as an explanation for acquiring a phobia using the Little albert study - Watson and Rayner.
Rat was the NS and the loud noise was the UCS which created a UCR.
The conditioning can then be generalised to similar objects.

Maintenance by operant conditioning:

Responses acquired by classical conditioning tend to recline over time but phobias are long lasting.
A phobic person will avoid the phobic stimulus a all costs. This is a type of negative reinforcement, by avoiding the stimulus, the person does not receive anxiety or distress
This reduction in fear reinforces the avoidance behaviour and so the phobia is maintained.

A02

Alternative explanation for avoidance behaviour:

Not all avoidance behaviour associated with phobias seems to be the result of anxiety reduction - at least not in more complex phobias like agoraphobia
Some avoidance behaviour seems to be motivated by positive feelings of safety.
This explains why some people with agoraphobia are able to leave the house with a trusted person as they feel safe in their company and so there is no need to avoid the phobic stimulus.
Limitation: The two-process model suggests that avoidance is motivated by anxiety reduction.

An incomplete explanation of phobias:

Evolutionary factors probably have an important role in phobias but the 2-process model does not mention this.
We easily acquire phobias of things that have been a source of danger in our evolutionary past.
Biological preparedness - the innate predisposition to acquire certain fears.
Not likely to develop fears of cars or guns presumably because they have not existed for very long even though they now pose a bigger threat
Limitation: There is more to acquiring phobias than just conditioning.

Phobias that don’t follow a trauma:

Sometimes people develop a phobia and are not aware of of having had a related bad experience.
The two process model is limited as it cannot explain these phobias and so it lacks in external validity.

Question 15

Describe and evaluate the use of the behavioural approach to the treatment of phobias.

Answer 15

A01

Systematic desensitisation:

Behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning.
Counterconditioning - a new response to the phobic stimulus is learned
Reciprocal inhibition - Impossible to be afraid and relaxed at the same time, so one emotion prevents the other.
1. The anxiety hierarchy
Least stressful situational to most stressful situation
2. Relaxation
Breathing exercises
3. Exposure

A02

It is effective:

Gilroy et al -> followed up 42 patients who had been treated for a spider phobia.]Used questionnaires and assessing response to a spider.
A control group was treated by relaxation without exposure.
At 3 months and 33 months, the SD group was less fearful than the control group.
Strength: Shows that SD is helpful in reducing anxiety and is long lasting

It is suitable for a diverse range of patients:

Flooding and cognitive therapies are not well suited to some patients.
Some sufferers of anxiety disorders may also have learning disabilities.
Can make it very hard for patients to understand what is happening in flooding or to engage in CBT - requires the ability to reflect on what you are thinking.
Strength: SD is probably the most suitable treatment.
(Flooding: Cost-effective, less effective for some patients, agoraphobias, and is traumatic)

It is acceptable to patients:

Those given the choice between SD and flooding usually choose SD.
Does not cause the same degree of trauma as flooding does.
May be also because SD includes elements that might be pleasant like relaxing.
Low refusal rates and low attrition rates.

Question 16

Describe and evaluate the 2 cognitive approaches to explaining depression.

Answer 16

A01

Beck’s cognitive theory of depression:

Faulty information processing:
We tend to focus on the negatives rather than the positives and blow small problems out of proportion.
Negative self-schemas:
The package of information we have about ourselves
We interpret all information about ourselves in a negative way.
The negative triad:
These are views that occur automatically regardless of the reality of what is happening.
- Negative view of the world
- Negative view of the future
- Negative view of the self

Ellis’ ABC model:

Irrational thoughts -> any thoughts that interfere with us being happy and free of pain
A- Activating event
B- Beliefs
C- Consequences

A02

It has good supporting evidence (Beck):

Grazioli and Terry -> 65 pregnant women
Found that those with higher cognitive vulnerability before having their babies were more likely to develop post-natal depression.
Clark and Beck -> Reviewed research from this topic and concluded that there was solid support for all the cognitive vulnerability factors.
These cognitions can be seen before depression develops depression and so Beck may be right about cognition causing depression.

They both have practical applications in CBT:

All cognitive aspects of depression can be identified and challenged.
Includes components of the negative triad and the ABC model.
Strength: These explanations translate well into therapies.

It doesn’t explain all aspects of depression -> E.g. why some people get very aggressive.
There are different types of depression (reactive depression and depression without a cause).
Ellis’ model doesn’t explain these and so it is only a partial explanation for depression.

Question 17

Describe and evaluate cognitive behaviour therapy for depression.

Answer 17

A01

Begins with an assessment in which the patient and the behavioural therapist work together to identify the problems.
They identify goals for the therapy and put a plan together to achieve them
Identify where there are irrational thoughts so that they can be challenged.

Beck’s CBT:

Identify the negative triad.
Then these thoughts must be challenged - central component of the therapy.
Aims to help patients test the reality of their negative beliefs.
May be set HW to record when something good happens - patient as scientist
The therapist can then use evidence provided by the patient in future sessions.

Ellis’ REBT:

D - Dispute
E - Effect
Identify and dispute irrational thoughts
Identify ‘musturbation’, ‘i-can’t-stand-it-itis’ and utopianism.
The vigorous argument is the key to REBT
Empirical arguments - involves disputing whether there s actual evidence to support the negative belief.
Logical arguments - Involves disputing whether the negative thoughts logically follow from the facts.
Behavioural activation - When the therapist encourages the patient to be more active.

A02

It is effective:

March et al -> Compared the effects of CBT and antidepressant drugs and a combination of both on teenagers with depression.
CBT group - 81% improved
Antidepressant group - 81% improved
CBT + Drugs group - 86% improved
Strength: suggests that there is strong evidence for making CBT the first choice of treatment in public health systems.

Success may be due to the therapist-patient relationship:

Differences between different methods of psychotherapy may be quite small.
All psychotherapies have a therapist-patient relationship.
Determines success rather than any particular technique
Simply having the opportunity to talk to someone who listens could be what matters most.

Overemphasis on cognition:

CBT can end up minimising the importance of the circumstances in which a patient lives.
Patients need to change their circumstances and any approach which emphasises what is happening in the patient’s mind rather than their environment can prevent this.
CBT techniques used inappropriately can demotivated people to change their situation.

Question 18

Describe and evaluate the biological approach to explaining OCD.

Answer 18

A01:

Genetic explanations:

Genes are involved in individual vulnerability to OCD.
Lewis observed that of his OCD patients, 37% had parents with OCD, 21% had siblings with OCD.
Suggests OCD runs in the family
What is probably passed on is the genetic vulnerability and not the certainty of OCD.
Diathesis-stress model -> certain genes leave some people more likely to suffer a mental disorder - some environmental stress is necessary to trigger the condition.

Candidate genes:

The genes that create vulnerability for OCD
Some are involved in regulating the production of serotonin

OCD is polygenic:

This means that several genes can cause OCD
Taylor -> analysed findings of previous studies and found that 230 different genes may be involved in OCD.
Genes that have been studied are associated with the action of dopamine, serotonin - have a role in regulating mood.

Different types of OCD:

One group of genes may cause OCD in one person but a different group may cause OCD in another person.
Some evidence to suggest that different types of OCD may be the result of particular genetic variations.

A02

There is good supporting evidence:

Evidence to show that people are vulnerable to OCD as a result of their genetic make-up
Nestadt et al -> reviewed previous twin studies.
Concordance rates for MZ were 68% and for DZ 31% - suggests strong genetic basis

Twin studies are flawed as genetic evidence:

Make the assumption that identical twins are only more similar than non-identical in terms of their genes.
Overlook the fact that identical twins may also be more similar in terms of environments.
Suggests that there is not an entirely genetic cause.

Too many candidate genes:

Psychologists have been less successful at pinning down all the genes involved.
Several genes are involved and each gene variation only increases the risk of OCD by a fraction.
Limitation: Genetic explanation is unlikely to be useful because it provides little predictive value.

Question 19

Describe and evaluate the biological approach to the treatment of OCD.

Answer 19

A01

Drug therapy:

Increase/decrease levels of neurotransmitters in the brain to increase/decrease activity.
SSRIs
Serotonin is released by the presynaptic neuron.
It diffuses across the synapse where it is then reabsorbed by the postsynaptic neuron.
It is then reabsorbed by the presynaptic neuron.
SSRIs prevent the reuptake of serotonin molecules by the presynaptic neuron.
This then continues to stimulate the postsynaptic neuron which increases activity levels in the brain.

Combining SSRIs with other treatments:

Drugs are often used alongside CBT when treating OCD
Drugs reduce the patient’s emotional symptoms and so they can engage more with the CBT.

Alternatives to SSRIs:

When SSRIs are not effective
Tricyclics
SNRIs (serotonin-noradrenaline reuptake inhibitors)

A02

Drugs are cost-effective and non-disruptive:

They are cheap compared to psychological treatments
Therefore good value for public health systems like the NHS
SSRIs are non-disruptive to patient’s lives and you can simply take the drugs until your symptoms decline and not engage in CBT
Many doctors and patients like drug treatments for these reasons

Drugs can have side-effects:

A significant minority will get no benefit
Indigestion, blurred vision, and loss of sex-drive - side-effects are normally temporary
Clomipramine - side-effects are more common and can be more dangerous
tremors, weight gain, agression, disruption to blood pressure and heart rythm.
Limitation: reduce effectiveness because people stop taking them.

Unreliable evidence for drug treatments:

There is some controversy.
Some psychologists believe that the evidence favouring drug treatments is biased because the research is sponsored by drug companies who do not report all the evidence.

Question 20

Describe and evaluate flooding as a treatment for Phobias.

Answer 20

A01

Involves exposing phobic stimulus to the phobic patients.
Immediate exposure.
Sessions last 3 hours and sometimes only one session is necessary.

How does it work:

Without the option of avoidance behaviour the patient quickly learns that the phobic stimulus is harmless.
Process is called extinction.
A learned response is extinguished when the CS is encountered without the UCS.
No longer produces CR.
In some cases the patient may achieve relaxation in the presence of the phobic stimulus because they become exhausted by their own fear response.

Ethical safeguards:

Unpleasant experience so it is important that patients give fully informed consent and are fully prepared.
Patient would be given the option to choose SD.

A02:

Cost-effective:

Studies comparing flooding to cognitive therapies have found that flooding is highly effective and quicker than alternatives.
Strength: means that patients are free of their symptoms as soon as possible and that makes their treatment cheaper.

It is less effective for some types of phobia:

Not effective for social phobias.
May be because social phobias have cognitive aspects.
This type of phobia may benefit more from cognitive therapies because they tackle irrational thoughts.

Treatment is traumatic for patients:

Patients are often unwilling to see it till the end.
Limitation: time and money are sometimes wasted preparing patients only to have them refuse to start or complete treatment.

Question 21

Describe and evaluate the biological approach (neural explanations) to OCD.

Answer 21

A01

The role of serotonin:

Serotonin helps regulate mood.
Neurotransmitters relay info from one neutron to another.
Low serotonin = normal transmission of mood relevant info doesn’t take place and mood is affected.
Some cases of OCD can be explained by a reduction in the functioning of the serotonin system in the brain.

Decision making systems:

Some cases of OCD seem to be associated with impaired decision making.
Abnormal functioning of the frontal lobe.
Responsible for logical thinking and decision making.
Parahippocampal gyrus functions abnormally - associated with processing unpleasant info.

A02

There is some supporting evidence:

Some antidepressants work solely on the serotonin system, increasing levels of serotonin.
Effective in reducing symptoms of OCD and so this suggests the serotonin system is involved.
OCD symptoms form part of a number of other conditions that are biological in origin.
Suggests that the biological processes that cause the symptoms in those conditions may also be responsible for OCD.

We should not assume the neural mechanisms cause OCD:

The causation correlation principle.
Could be that OCD causes abnormal functioning of the structures of the brain.

The serotonin-OCD link may be simply co-morbidity with depression:

Many OCD patients become depressed.
Depression involves disruption to the serotonin system.
It could simply be that the serotonin system is disrupted in many patients with OCD because they are depressed as well.