Psychopathology Flashcards
what is a specific phobia
- phobia of an object or situation
what is social anxiety (social phobia)
- phobia of a social situation
what is agoraphobia
fear of being outside or in a public space
what are the behavioural, emotional and cognitive characteristics of phobias (table)
behavioural:
panic / avoidance / (lack of) endurance
emotional:
anxiety / unreasonable responses
cognitive
selective attention / irrational beliefs / cognitive distortions
explaining phobias using the behavioural approach (outline)
- 2 process model
- classical conditioning acquires phobias
- operant conditioning maintains phobias
explain the process of classical conditioning in acquiring phobias
- a UCS stimulates a UCR
this is an unlearned, natural connection
e.g an injection stimulates anxiety - the NS is present
e. g injection + doctor stimulates anxiety - NS is conditioned to be the CS, and the CS stimulates a CR
eg doctor now stimulates anxiety
unlike the usual model of CC, this process doesn’t need to be repeated to acquire a phobia
explain the process of operant conditioning in maintaining phobias
- this process uses negative reinforcement
- phobics typically avoid the phobic object or situation, and this leads to reduced anxiety
- the reduced anxiety reinforces the avoidance behaviour, and maintains the phobia
study of little albert
Watson and Rayner (1920)
- Albert was presented a rat, which he tried to play with
- every time he saw the rat, they would make a loud noise and scare albert
- albert associated the fear with the rat, which now produced the fear response even without the loud noise
- Watson and Rayner observed that this phobia generalised
- once scared of rats, little albert also became scared of fur coats and beards
- the study of little albert is evidence for CC in acquisition of phobias
operant conditioning evaluation (therapies)
phobia therapies involve exposure to object / situation
this prevents negative reinforcement
- lack of reinforcement makes phobia extinct
- shows negative reinforcement is the cause
- very successful - strong evidence for operant conditioning in maintaining phobias
why is it hard to test CC and OC theories for phobias
what technique could you use instead to investigate
- these studies would involve giving people phobias
- this raises ethical issues
- surveys
- ask phobics and non phobics to recall traumatic experiences
- expect higher levels of traumatic experiences in phobics
DiNardo study
- cc in acquisition of phobias
- 60% of dog phobic people related their phobia to a traumatic experience
- however similar levels in a non phobic control group
conclusion:
- limited evidence due to weak methodology and weak results
- suggests there are other factors that play a role
alternative explanation to CC in acquisition of phobias
- genetics
theory:
some people may inherit genes that make them more (or less) likely to develop phobias
evidence: twin studies
MZ - 20-25% concordance
DZ - 10-15% concordance
- shows a small part is played by genetics but not overly significant
alternative explanation to CC in acquisition of phobias
- social learning
theory:
- phobias acquired vicariously through imitation
- observe models (eg parents) fearing an object or situation
explanation for why some phobias are more likely to be acquired than others
- evolutionary preparedness
- we have an innate disposition to acquire phobias of what used to pose a threat in our evolutionary past
- fear would have been beneficial to motivate people to seek safety
- eg snakes, darkness, spiders
- new inventions do not have innate dispositions so we are less likely to fear them
- even if they could threaten us
- eg cars, gun, electricity
alternative explanation to OC in maintenance of phobias
- it is desire to remain safe that maintains phobia (not reduction of anxiety)
- eg agoraphobics may be able to go out when with someone else
outline of behavioural therapies for treating phobias
outline
- involve exposure
flooding:
extreme version of fear is encountered
systematic desensitisation:
- gradual exposure to phobia
- most common
both use counterconditioning - learning a new response to phobia
the aim is to prevent the negative reinforcement of operant conditioning
process of systematic desensitisation
1) patient makes an anxiety hierarchy
- scale showing what causes increase of anxiety
2) variety of techniques to relax patient
- breathing exercises
- imagery techniques
- drug treatment
3) gradual exposure to phobia
- takes several shorter sessions
- increases intensity slowly
- less traumatic
process of flooding
- involves massive, immediate, repeated exposure
- more traumatic
- few longer sessions
- CS (dog) experiences without UCS (bite)
- extinction of phobia
- anxiety levels drop with each exposure
evaluation of systematic desensitisation
- it works and has long lasting effects
- effective across a range of phobias
- suitable for a diverse range of people
evaluation of flooding
- as effective as SD, possibly better
- Barlow (2002) meta analysis concluded flooding and SD are equal
- Choy (2007) meta analysis concluded flooding is marginally better
- cost effective
- less effective for some types of phobias eg social
however flooding raises ethical issues to do with stress and protection from harm
what is major depressive disorder?
- severe but often short term depression
what is persistent depressive disorder?
- long term / recurring depression
what is the lifetime risk of depression?
15%
females - 20%
males - 10%
what are the behavioural, emotional and cognitive characteristics of depression?
behavioural:
lowered activity levels / disruption to sleep/eating / aggression and self harm
emotional:
lowered mood / anger / lowered self esteem
cognitive:
poor concentration / dwelling on negatives / absolutist thinking
cognitive approach to explaining depression
- beck’s theory
theory:
some people think in ways which make them more cognitively vulnerable to depression
those who are depressed are a subset of the cognitively vulnerable
what is cognitive vulnerability
- thinking styles that precede depression
- this is not a cause of depression on its own
Beck’s negative triad - explaining depression
negative view of self
^ >
negative view of future < negative view of world
when are negative schemas developed
some examples
acquired in childhood and adolescence
- loss of a parent
- peer rejection
- emotional / physical abuse
explaining depression - Ellis’ ABC model
A - activating event triggers
B - beliefs which are irrational, this produces
C - consequences - an emotional response
what is an irrational belief
- the 3 types
- any belief that interferes with our ability to be happy and free of emotional pain
- musturbation ‘I must always succeed’
- I-cant-stand-it-itis ‘if things don’t happen as planned’
- utopianism ‘I want everything to be fair’
evaluation of beck’s negative triad and Ellis’s ABC
- evidence is correlational so you cannot draw causal conclusions
- should be investigated using longitudinal studies
evidence for Beck’s negative triad
- Grazioli and Terry
- measured cognitive vulnerability in pregnant women prenatal
- found that those who had high cognitive vulnerability were more likely to develop depression post natal
- indicates a causal relationship
complementary explanation for cause of depression
- genetics
Kendler twin study
MZ - 46%
DZ - 20%
genetics must play a role in who is cognitively vulnerable
Becks cognitive therapy for treating depression
CBT - cognitive behavioural therapy
1 - identify negative beliefs about self world and future
2 - challenge beliefs by testing reality against evidence
3 - homework where patient takes role of therapist and tries and records new coping techniques
Ellis’ cognitive therapy for treating depression
REBT - rational-emotive behavioural therapy
follows ABC theory
adds D - dispute
E - effect
- challenges irrational thoughts through:
1 - empirical argument
-patient is factually mistaken
2 - logical argument
- shows patient has drawn unjustified conclusion about event
3 types of studies to investigate depression
1 - prospective studies
- studies of high risk groups before depression, followed by study after depression
2 - therapy studies
- use cognitive theories as a basis for studies
- if therapy is successful, suggests explanation is correct
3 - laboratory studies
- shows how people react differently to laboratory studies based on whether they have depression
March et al
study into effectiveness of drug treatment vs CBT
March et al (2007)
- compared the improvement of patients with CBT, with antidepressant drugs, and with a combination of both
CBT drugs both improvement 88% 88% 94% no improvement 21% 21% 15%
conclusion:
CBT is as effective as drug treatment, and helpful alongside medication
Cujpers et al
meta analysis into effectiveness of CBT
procedure
inclusion criteria:
- random allocation
- blind procedures
results
- found an effect size of 0.71 - medium to large
the average person in the CBT condition improved more than 75% of the control condition
evaluation:
due to publication bias, this effect size may be bigger than in reality
conclusion:
CBT seems to be an effective therapy, although possibly not as effective as the meta analysis suggests
appropriateness of CBT
- CBT may not be appropriate for more severe cases of depression
- severely depressed patients may lack motivation and attention
solution:
- use drug treatments initially to increase motivation and attention
why is CBT effective
Luborsky (2002) suggested it was not specifically about the cognitive components but about the generic features of therapies
Luborsky found very small differences between types of therapies
- therapist- patient relationships
- confidentiality
cost of CBT
Very cost effective
- designed to be 12 sessions long
disadvantages of CBT
patients expect to talk about the past which CBT doesn’t do
OCD cycle
obsessive thought
temporary relief anxiety
compulsive behaviour
emotional, cognitive and behavioural characteristics of OCD
emotional
anxiety
cognitive
obsessive thoughts
behavioural
compulsions
neural explanation for OCD
serotonin as a neurotransmitter
- serotonin regulates mood and decision making
- serotonin has a role in preventing impulses
- low levels may lead to OCD
- studies using PET and fMRI scans support this theory
other evidence:
- SSRI’s affect serotonin levels and can be effective in treating OCD
however, depression is caused by low levels of serotonin.
depression and OCD are comorbid
therefore findings may not be accurate
brain structure as an explanation for OCD
frontal lobe has a role in decision making and logical thought
- in patients with OCD, frontal lobe may be impaired
- associated with hoarding disorder and obsessions
- studies using brain scans have supported this theory
However, brain impairments may be a consequence rather than a cause
It is not fully understood which areas cause OCD
Ursu and Carter
Saxena and Rauch
- monitored brain activity in OCD patients
- fMRI scans
- found hyperactivity
- found consistent association between FC and OCD
biological approach for explaining OCD
theory:
OCD may be heritable because it is a mental state and brain structure is determined by genes
what is the OCD baseline risk
2.5%
Lewis
family study into OCD
- OCD patient was index case
- 37% of parents have OCD
- 21% siblings have OCD
suggests a small biological basis, however numbers are lower than wholly genetic
- doesn’t separate nature from nurture
Nestad et al - meta analysis
Twin study into genetic influence of OCD
- reviewed previous twin studies
MZ 68%
DZ 31% - suggests genetic influence as MZ rate is higher than DZ
- MZ figure lower than 100% so suggests other factors are involved too
Explain the diathesis stress model for OCD
Molecular genetics
Diathesis = vulnerability = genetics Stress = triggers = environmental
Theory:
genetics increase how vulnerable an individual is to developing OCD
Environment determines which of the vulnerable individuals develop OCD
Molecular genetics is a subject that identifies potential individual genes that increase vulnerability of OCD
Cromer et al study
Study into environmental factors in development of OCD
- 265 OCD patients
- 54% had experiences serious lifetime events
- more traumas led to higher risk
(Serious events E.g. Victim of an accident, death witnessed, victim of sexual abuse)
Taylor meta analysis of molecular genetics
2013
Identified serotonin related genes linked to OCD
- 5HTTLPR
- HTR2A
230 genes associated with OCD
Many associated with serotonin levels
Conclusion:
OCD is polygenic
Results are preliminary - few findings have been replicated
What are the implications of development of treatments for mental illnesses on the economy?
- absence from work costs £15 billion per year
- 1/3 absences caused by mental illness
Treatments include:
Psychotherapeutic drugs
- SSRI’s
- antianxiety
Psychotherapy
- systematic desensitisation
- flooding
- psychological research =sufferers manage their condition and return to work
- economic benefit
Explain one criticism of neural explanations
- brain scans
- correlational
- no iv manipulated
- cannot draw causal conclusions
Explain how SSRI’s work
What does ssri stand for
- most common treatment
- increase levels of serotonin
- ssri inhibits reabsorption into the presynaptic nerve
- serotonin remains in synapse
- equivalent of having more serotonin
- dosage 20-60mg
- capsule or liquid
5 types of antidepressants
- SSRI’s
- tricyclics
- SNRI’s
- anti anxiety drugs
- anti psychotic drugs
- these can have serious side effects
A short term benefit of combining drugs with CBT
A long term benefit of combining drugs with CBT
Short term - drugs help patients engage effectively with CBT
Long term - CBT gives coping strategies to use when they are no longer on medication
Evaluation of drug therapy - appropriateness
+ cost effective, non disruptive and non time consuming
- can have side effects - although usually temporary are uncomfortable
Evaluation of drug therapy - effectiveness
meta analysis - Soomro 2009, of drug studies - 17 studies showed SSRI’s are significantly beneficial. 70% patients benefited
- do not provide coping mechanisms for future
+ SSRI’s effective at treating OCD - sponsored by drug companies
- this leads to cherry picking and the file drawer problem (publication bias)
- this makes drug treatments look more effective than in reality
solution:
require all trials to be registered before being conducted
