Psychopathology

Question 1

Defining abnormality: Deviation from social norms

Answer 1

− Social norm – unwritten rules about what is expected or acceptable behaviour in a particular social group or situation
− IMPLICT social norm – unwritten conventions or rules regarding behaviour
− EXPLICIT social norm – more formal + written ideals that not only deviate from social norms but may also be breaking the law
− Social standards are concerned with rules of etiquette as well as more serious moral issue e.g. expectable sexual behaviour – in the past homosexuality was classified as deviant behaviour + was even against the law, currently the DSM classification system contains a category called ‘sexual + gender identity disorders’ which included paedophilia + voyeurism such behaviours are considered socially deviant

Question 2

Evaluation of deviation from social norms: Social norms change over time :(

Answer 2

P: social norms change over time
E: deviance is related context and attitudes towards behaviour can change over time, e.g. homosexuality used to be considered deviating from social norms + was even diagnosed as a mental disorder (USA until 1973 defined by the DSM) + an offence
C: things that are seen as abnormal may be seen as normal at a later date this lessens our trust + beliefs of what we are told is abnormal

Question 3

Evaluation of deviation from social norms: Eccentricity vs abnormal :(

Answer 3

P: eccentricity vs abnormal behaviour – it is difficult to distinguish between eccentric + abnormal behaviour
E: behaviour that deviates from the norm e.g. men wearing make up or extravagant fashion choices may merely be eccentric rather than abnormal in a pathological sense
C: only particular kinds of abnormal behaviour tend to be regarded as pathological – lead to miss diagnostic

Question 4

Evaluation of deviation from social norms: Behaviour that is deviant is socially unacceptable :)

Answer 4

P: behaviour that is deviant is socially unacceptable for the rest of us
E: this was of defining abnormality takes into account the greater good of society + distinguishes between desirable + undesirable behaviour (feature that is absent from the statistical model)
C: according to the definition abnormal behaviour is behaviour that damages others

Question 5

Evaluation of deviation from social norms: Recognises context :)

Answer 5

P: it recognises the role of context i.e. situational norms
E: the context of behaviour is important as differing situations can change whether a behaviour is abnormal and potentially a symptom of mental health e.g. shouting at a football match is a normal behaviour but shouting in the middle of the street can be a sign of deteriorating metal health

Question 6

Defining abnormality: Failure to function adequately (FFA)

Answer 6

− Considers abnormality from the individuals point of view
− Most people aim to be able to cope with day-to-day living – abnormality can then be judge in terms of not being able to cope e.g. eating properly, going to school/work + have social relations
− Failure to function adequately is measured by the global assessment of functioning scale (GAF) – considers psychological, social + occupational functioning on a hypothetical continuum of metal health-illness, ranks in terms of code from 0-100 e.g. code 10 patients display persistent danger of severely hurting self or others (recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death
− Definition includes bizarre behaviours +/or behaviours that distress others
− Rosenhan + Seligman suggested characteristics related to ‘failure to functions adequately’:
→ Personal distress – e.g. depression + anxiety disorders
→ Maladaptive behaviour – behaviour that prevents life goals both socially + occupationally
→ Unpredictability – unpredictable behaviours characterised by loss of control e.g. suicide attempt after failing a test
→ Irrationality – behaviour that cannot be explained in a rational way

Question 7

Evaluation of failure to function adequately: Easy to judge objectively :)

Answer 7

P: In addition, ‘failure to function’ is also relatively easy to judge objectively,
E: because one can use a checklist of common behaviours they would expect in someone deemed normal e.g. can dress self, can prepare meals,
C: …which is straightforward to use because it focuses on observable behaviour.

Question 8

Evaluation of failure to function adequately: Does not indicate abnormal behaviour :(

Answer 8

P: Failure to function adequately does not always indicate abnormal behaviour.
E: Certain factors can affect our ability to function adequately e.g. exam stress, death of a loved one. These can have a temporary impact on an individual’s functioning and does not necessarily indicate abnormality.
C: Therefore, the context in which the behaviour occurs must always be considered.

Question 9

Evaluation of failure to function adequately: Culturally varied :(

Answer 9

P: Standard patterns of behaviour in terms of what it means to ‘function adequately’ vary from culture to culture
E: e.g. there may be cultural variations in what it means to maintain good levels of personal hygiene.
C: Therefore, an individual may be considered normal in one culture but abnormal elsewhere.

Question 10

Evaluation of failure to function adequately: Abnormality is not always accompanied by dysfunction

Answer 10

P: Abnormality is not always accompanied by dysfunction.
E: Individuals may be functioning adequately e.g. attending school/work, maintaining good personal hygiene, despite clinical levels of anxiety and depression.
E: Harold Shipman is a good example of someone who was abnormal, murdering at least 215 of his patients, yet he did not outwardly display any features of dysfunction.
C: Therefore, according to this definition some abnormal individuals would be considered normal.

Question 11

Defining abnormality: Deviation from ideal mental health

Answer 11

− Johoda argued that we define physical illness by looking at the absence of signals of physical heath e.g. having correct body temperature + normal blood pressure etc. therefore we should apply the same principles to diagnosing metal illness
− Johoda’s six categories of ‘ideal mental health’:
1. Self-actualisation – experiencing person growth + development, becoming everything one is capable of become
2. Accurate perception of reality – perceiving the world in a non-disordered fashion, having an objective + realistic view of the world
3. Environmental mastery – being competent in all aspects of life + able to meet the demands of any situation, having the flexibility to adapt to changing life circumstances
4. Resisting stress – having effective coping strategies + being able to cope with every day anxiety provoking situations
5. Autonomy – being independent, self-reliant + able to make personal decisions
6. Positive attitude towards oneself – having self-respect + a positive self-concept

Question 12

Evaluation of deviation from ideal mental health: Most people would find in difficult to achieve all 6 criteria all of the time :(

Answer 12

P: Most people would find it difficult to achieve all six criteria, all of the time.
E: For example, many people can find it difficult to achieve self-actualisation and experience personal growth all the time. Some individuals may be content working in Tesco’s, even if they have the potential to be a brain surgeon!
C: This therefore implies that most of us are abnormal! It is also unclear how many of the criteria you have to be lacking in order to be classed as mentally ill.

Question 13

Evaluation of deviation from ideal mental health: Culturally biased :(

Answer 13

P: Jahoda’s ideas are based on Western ideals of self-fulfilment and individuality.
E: For example, autonomy and self-actualisation are not valued in collectivist cultures. Why? What do they value and promote instead?
C: Therefore, this definition would be difficult to apply in these cultures.

Question 14

Evaluation of deviation from ideal mental health: Some criteria are vague + difficult to measure :(

Answer 14

P: Several of the criteria are vague and difficult to measure, relying heavily on the self-reports of patients, which could be unreliable (highly subjective)…
E: …whereas physical health can be measured more objectively e.g. X-rays, blood tests.
C: This therefore undermines Jahoda’s ideas about measuring mental health in the same way as physical health.

Question 15

Evaluation of deviation from ideal mental health: Positive approach to mental health :)

Answer 15

Positive approach to judging mental health: Jahoda’s definition emphasises positive achievements rather than failures (e.g. Failure to function adequately) and stresses a positive approach to mental problems by focusing on what is desirable, rather than undesirable.

Question 16

Defining abnormality: Statistical infrequency

Answer 16

− Research + government agencies collect statistics to inform us what is normal e.g. average show size
− Statistics can be sued to define the ‘norm’ (something regular or typical) for any group of people – if we can define common/normal then we can also define what is uncommon + not normal
− Most aspects of human behaviour produced a normal distribution graph (illustrated by a bell shaped curve) – in a normal distribution most people (‘normal’) are in the central group clustered around the mean + fewer people (‘abnormal’) are at either extreme

Question 17

Evaluation of statistical infrequency: not all abnormal behaviour is undesirable :(

Answer 17

P: Not all abnormal behaviour is undesirable
E: Very few people have an IQ over 150, but we wouldn’t view that as undesirable
e.g. Einstein - Equally, there are some ‘normal’ (i.e. common) behaviours that are undesirable
C: This therefore suggests that although this definition provides a method for measuring typical behaviours within the population, it does not indicate which characteristics might be related to abnormal behaviour e.g. left-handedness is rare but has no bearing on abnormality!

Question 18

Evaluation of statistical infrequency: Difficult to decide the cut off point :(

Answer 18

P: It is difficult to decide where the cut-off point should be for defining abnormality
E: There is no agreed point on the scale at which behaviour is classified as abnormal.
C: Therefore, it is not clear how far behaviour should deviate from the norm to be seen as abnormal.

Question 19

Evaluation of statistical infrequency: Culturally relative :(

Answer 19

P: The statistical infrequency model is culturally relative (it only relates to the culture the statistics were generated in), in that behaviours that are statistically infrequent in one culture may be more frequent in another.
E: For example, depression, a frequently diagnosed disorder in Western cultures, appears to be absent in Asian cultures.
C: This could be because Asian people tend to live with extended family, with ready access to social support (collectivist cultures), whereas families tend to be more widely dispersed (geographically) in individualistic cultures.

Question 20

Evaluation of statistical infrequency: Gender differences :(

Answer 20

P: There are gender differences in statistical data reporting mental health disorders, however, this data could be misleading.
E: Females are more likely than males to consult their doctor for anxiety problems, whereas males are more likely to bottle up their anxiety, or try to deal with it in physical ways, such as through vigorous sporting activity, or self-medicate using drink, drugs or gambling. Males might also perceive mental health services as feminised.
C: This again suggests that statistics may not necessarily reflect the true occurrence of mental disorders amongst males and females.

Question 21

Characteristics of abnormality: Phobias - Emotional

Answer 21

Persistent, excessive fear – phobias produce high levels of anxiety due to the presence of or anticipation of the feared object/situation
Fear from exposure to phobic stimulus – phobias produce an immediate fear response even panic attacks due to the presentation of the feared object/situation

Question 22

Characteristics of abnormality: Phobias - Behaviour

Answer 22

Avoidance/anxiety – produces high anxiety responses, effort made to avoid the feared object/situation in order to reduce the chances of such anxiety response occurring
Disruption of function – when responses are so extreme that they severely interfere with the ability to conduct everyday working + social functioning

Question 23

Characteristics of abnormality: Phobias - Cognitive

Answer 23

Recognition of exaggerated anxiety – generally phobics are consciously aware that the anxiety levels they experience in relation to their feared object/situation are overstated

Question 24

Characteristics of abnormality: Unipolar depression - Emotional

Answer 24

Loss of enthusiasm – less concerned with/lack of pleasure in daily activities
Constant depressive mood – overwhelming feelings of sadness/hopelessness
Worthlessness – constant feelings of reduced worth +/or inappropriate feelings of guilt

Question 25

Characteristics of abnormality: Unipolar depression - Behavioural

Answer 25

Loss of energy – fatigue, lethargy, inactivity
Social impairment – reduced levels of social interactions
Weight changes – decrease or increase
Poor personal hygiene – reduced incidence of washing, wearing clean clothes,
Sleep pattern disturbance – constant insomnia or over sleeping

Question 26

Characteristics of abnormality: Unipolar depression - Cognitive

Answer 26

Delusions – generally concerning guilt, punishment, personal inadequacy or disease, some will experience hallucinations
Reduced concentrations
Thoughts of death
Poor memory

Question 27

Characteristics of abnormality: Bipolar depression - Emotional (same as unipolar plus …)

Answer 27

Elevated mood states – ‘high’ moods’ + intense feelings of euphoria
Irritability – often frustrated + irritable if they don’t get there way immediately
Lack of guilt – social inhibition + a general lack of guilt concerning behaviour

Question 28

Characteristics of abnormality: Bipolar depression - Behavioural (same as unipolar plus …)

Answer 28

High energy levels – boundless energy, increases work output, increased social interactions/sexual activity
Talkative – fast endless speech without regard for what others are saying

Question 29

Characteristics of abnormality: Bipolar depression - Cognitive (same as unipolar plus …)

Answer 29

Delusions – grandiose, believe others are persecuting them

Irrational thought processes – reckless + irrational thinking + decision making

Question 30

Characteristics of abnormality: Obsessions (OCD) - Emotional

Answer 30

Extreme anxiety – persistent inappropriate or forbidden ideas create excessive levels of anxiety

Question 31

Characteristics of abnormality: Obsessions (OCD) - Behavioural

Answer 31

Hindered everyday functioning – obsessive ideas of a forbidden/inappropriate type create such anxiety that the ability to perform everyday functions is severely hindered
Social impairment – anxiety levels generated are so high as to limit the ability to conduct meaningful interpersonal relationships

Question 32

Characteristics of abnormality: Obsessions (OCD) - Cognitive

Answer 32

Recurrent + persistent thoughts – constant repeated obsessive thoughts and ideas of an intrusive nature
Recognised self-generation – understand its self-invented, not external
Realisation of inappropriateness – understand this but cannot control obsessive thoughts
Attentional bias – perception tents to be focuses on anxiety generated stimuli

Question 33

Characteristics of abnormality: Compulsions (OCD) - Emotional

Answer 33

Distress – the recognition that compulsive behaviours cannot be consciously controlled can lead to strong feelings of distress

Question 34

Characteristics of abnormality: Compulsions (OCD) - Behavioural

Answer 34

Repetitive – compelled to repeat behaviours as a result to an obsession
Hinder everyday functioning – performance of repetitive, compulsive behaviours can seriously disrupt the ability to perform everyday functions
Social impairment – disrupts the ability to conduct meaningful relations

Question 35

Characteristics of abnormality: Compulsions (OCD) - Cognitive

Answer 35

Uncontrollable urges – to perform acts they feel will reduce the anxiety caused by obsessive thoughts
Realisation of inappropriateness – understand this but cannot consciously control them

Question 36

OCD - Obsessions vs Compulsions

Answer 36

Obsessions – what people think about

Compulsions – the behavioural actions due to the obsessions

Question 37

The behavioural approach to explaining and treating phobias: Classical conditioning

Answer 37

− Classical conditioning (e.g. a phobia of dogs) – initiation of phobias
→ The unconditioned stimulus is being bitten that brings about an unconditioned response of fear, the neutral stimulus is the dog
→ Through presenting the neutral stimulus of the dog with the unconditioned stimulus of being bitten an association is made bet. the two
→ The neutral stimulus of the dog then becomes a conditioned stimulus with a conditioned response of fear

Question 38

The behavioural approach to explaining and treating phobias: Operant conditioning

Answer 38

− Operant conditioning – maintenance of phobias
→ Positive reinforcement: when you are afraid of something you generally receive attention + sympathy this gives someone an incentive to having a fear + increases the likelihood that it will occur in the future
→ Negative reinforcement: the avoidance response/escape from the phobic stimulus reduces fear which increases the likelihood that it will recur in the future

Question 39

The behavioural approach to explaining and treating phobias: The two process model - classical + operant conditioning

Answer 39

− Orval Hobart Mowrer proposed the two process model to explain how phobias are learned – the first stage is classical conditioning + then in the second stage operant conditioning occurs these two processes can explain the initiation + maintenance of a phobia

Question 40

Evaluation if the behavioural approach to explaining and treating phobias: Treatments :)

Answer 40

Treatments such as systematic desensitisation + flooding use conditioning techniques based on behaviourist principles – the fact that they are successful shows that phobias are manipulative behaviours acquired by learning therefore they can be unlearned by replacing them with more adaptive behaviour

Question 41

Evaluation if the behavioural approach to explaining and treating phobias: Research support :)

Answer 41

− There is research evidence to support the theory e.g. the case of Little Albert (Watson + Rayner, 1920) supports the two process model + the idea that phobias are acquired through classical conditioning

Question 42

Evaluation if the behavioural approach to explaining and treating phobias: The diathesis stress model :(

Answer 42

− The diathesis-stress model suggests that we inherit a genetic vulnerability for developing mental disorders however a disorder will only manifest itself if triggered by a life event
→ DiNardo et al found that not everyone who is bitten by a dog develops a phobia of dogs which goes against the behaviourist theory that suggests that a dog bite would only lead to a phobia

Question 43

Evaluation if the behavioural approach to explaining and treating phobias: Doesn’t apply to everyone :(

Answer 43

− Not everyone who has had a phobia can recall a specific event when their phobia appeared which is a direct criticism of classical conditioning
→ :) However, Ost suggests that it is possible that such traumatic events did happen but have since been forgotten

Question 44

Evaluation if the behavioural approach to explaining and treating phobias: Biological preparedness :(

Answer 44

− Biological preparedness (Martin Seligman, 1970) suggests that animals (inc. humans) are genetically programmed to rapidly learn an association bet. potentially life-threatening stimuli + fear
→ These stimuli are known as ancient fears – things that would have been dangerous in our evolutionary past i.e. snakes, heights, it would therefore have been adaptive to rapidly learn to avoid such stimuli
→ Biological preparedness explains why people are less likely to develop fears of modern objects i.e. cars which are more of a threat than spiders as such items were not a danger in out evolutionary past
→ Behavioural explanations alone cannot be used to explain the development of phobias

Question 45

Systematic desensitisation

Answer 45

− A behavioural therapy for treating anxiety disorders in which the sufferer learns relaxation techniques + then faces a progressive hierarchy of exposure to the objects + situation that cause anxiety
STEP 1: Patient is taught progressive muscle relaxation techniques (Reciprocal Inhibition: a relaxed state is incompatible with anxiety)
STEP 2: Therapist + patient together construct a desensitisation heirarchy of anxiety provoking situations: Least feared types of contact with phobic stimulus to most feared types of contact with phobic stimulus
STEP 3: Patient gradually works his/her way through desensitisation hierarchy, practicing relaxation at each stage (Convert/In Vitro Desensitisation: imagined exposure to the phobic stimulus, In Vivo Desensitisation: actual exposure to the phobic stimulus
STEP 4: Once the patient has mastered one step in the hierarchy they are ready to move onto the next
STEP 5: Patient masters the feared situation

Question 46

Evaluation of systematic desensitisation: Successful :)

Answer 46

− SD is successful for a range of phobic disorders
→ McGrath et al: 75% of patients with phobias respond to SD
→ Jones used SD to eradicate ‘Little Peter’s’ phobia of white fluffy animals/objects i.e. rabbits – the rabbit was presented at closer distances each time anxiety levels subsided, he was rewarded with food to develop a positive association towards the rabbit and consequently developed affect for the rabbit which generalised onto similar animals/objects

Question 47

Evaluation of systematic desensitisation: No side-effects :)

Answer 47

Unlike drug therapy + ECT there are no side effects from SD + no risk of addiction or dependency

Question 48

Evaluation of systematic desensitisation: Risk of symptom substitution :(

Answer 48

− Risk of symptom substitution: SD only deals with the symptoms + not the root cause of the phobia so there is a risk that the symptoms will resurface possibly in another form
→ e.g. the case of Little Hans + his phobia of horses (Freud): he projected his anxiety about his father into the horse if the therapist had treated the horse phobia the underlying problem might have remained + resurfaced elsewhere

Question 49

Evaluation of systematic desensitisation: In vivo found to be more effective :(

Answer 49

In vivo techniques have been found to be more effective + longer-lasting than in vitro as some individuals lack the ability to imagine the feared situations

Question 50

Evaluation of systematic desensitisation: Time consuming :(

Answer 50

SD is time consuming, therapies e.g. flooding which involve immediate exposure to the phobic stimulus would be a quicker alternative

Question 51

Flooding

Answer 51

− A behaviour therapy where instead of a step-by-step approach patients go straight to the top of the hierarchy + imagine of have direct contact with their most feared scenarios
− Through forced + prolonged exposure the idea is that patients cannot make their usual avoidance, anxiety peaks at such high levels it cannot be maintained + eventually subsides

Question 52

Evaluation of flooding

Answer 52

− :) For those patients who choose flooding as a treatment + do stick with it, it appears to be an effective treatment + is relatively quick (compared to CBT)
− :( Individual Difference: flooding can be highly traumatic + patients may quit during treatment which reduces the effectiveness of the therapy for some people
− :( Flooding is not suitable for patients who are not in good physical health as the extreme anxiety levels caused by confrontation with the phobic stimulus can be very stressful on the body

Question 53

The cognitive approach to explaining + treating depression: Beck’s negative triad

Answer 53

− Beck believes people become depressed because the world is seen negatively through negative schemas
− These negative schemas dominate thinking – leading to a negative view of the world + are triggered whenever individuals are in situation that are similar to those in which negative schemas were leaned
− Beck proposed that negative schemas develop during childhood + adolescence when authority figures e.g. parents place unrealistic demands on an individual + are highly critical of them therefore the schema leads them to expect to fail (their schema tells them to expect this based on past experience)
− Cognitive biases:
→ Selective abstraction: conclusions drawn from just one part of a situation e.g. a worker feeling worthless when a product doesn’t work even though several people made it
→ Overgeneralisation: sweeping to conclusions draw on the bias of a single event e.g. a student regarding poor performance on a test as proof of worthlessness
→ Arbitrary inferences: conclusions drawn in the absence of sufficient evidence
→ Magnification + minimisation: exaggerations in evidence of performance
− Beck claims that negative schemas + cognitive biases maintain what Beck calls the negative triad a pessimistic + irrational view of three key elements in a person’s belief system:

Negative views about the world: where obstascles are percieved within one’s environment that cannont be dealt with
“Everyone is against me because I’m worthless”
Negative views about the future: where personal worthlessness is seen as blocking any imporvements
“I’ll never be good at anything”
Negative views about oneself: where individuals seen themselves as being helpless, worthless + inadequate
“I’m worthless + inadequate”

Question 54

The cognitive approach to explaining + treating depression: Ellis’ ABC model

Answer 54

− Ellis believed that irrational thinking could lead to psychological disturbance mainly due to the fact that individuals fall into a cycle of irrational thinking which prevents the individual from behaving in an adaptive way
− Adaptive – being rational, a healthy response to a situation

(A) Adversity/Activating event
Actual event: 
Client's immediate interpretations of the event
(B) Beliefs:
Evaluations
Rational
Irrational
(C) Consequences:
Emotions
Behaviours
Other thoughts

Question 55

Evaluation of the cognitive approach to explaining + treating depression: Therapeutic success :)

Answer 55

P: Therapeutic success supports the cognitive approach to explaining depression
E: Cognitive behavioural therapy (CBT) is found to be the most effective treatment for depression especially when combined with drug treatments (Cuijpers et al.)
(CBT identifies irrational + maladaptive thoughts/beliefs + restructures them into more adaptive + rational ones)
C: This suggests that irrational/negative thoughts have a role in causing the depression in the first place

Question 56

Evaluation of the cognitive approach to explaining + treating depression: Research support :)

Answer 56

P: There is research support for the role of irrational thinking in depression
E: Hammen + Krantz found that depressed ppts made errors in logic when asked to interpret written material than non-depressed ppts
E: Bates et al found that depressed ppts who were given neg. automatic thought statements became more + more depressed – supporting the view that neg. thinking leads to depression

Question 57

Evaluation of the cognitive approach to explaining + treating depression: Issue of cause + effect :(

Answer 57

P: However there is a cause + effect issue
E: The fact that there is a link bet neg. thoughts + depression does not mean that neg. thoughts cause depression, it may be that a depressed individual develops a neg. way of thinking because of their depression i.e. the negative thoughts are a symptom of the depression
C: This therefore undermines the validity of both Ellis + Beck’s cognitive explanations + suggests that there may be other causes e.g. the neg. thoughts might have a biological cause e.g. low levels of serotonin

Question 58

Evaluation of the cognitive approach to explaining + treating depression: Irrational thought may be realistic :(

Answer 58

P: Neg./irrational thoughts might be realistic
E: Alloy + Abrahamson: depressive realists tend to see things for what they are (with normal ppl tending to view the world through ‘rose-coloured spectacles’) – they found that depressed ppl gave more accurate estimates of the likelihood of disaster then ‘normal’ controls, the ‘sadder but wiser’ effect
C: This therefore implies that not all beliefs are ‘irrational’ although they may simply seem irrational

Question 59

Evaluation of the cognitive approach to explaining + treating depression: Doesn’t acknowledge situational factors :(

Answer 59

P: The cognitive approach does not acknowledge current situational factors – it blames the client suggesting that they are responsible for their disorder
E: Irrational environments – certain environments may continue to produce + reinforce irrational thoughts + maladaptive behaviours e.g. life events/family problems may have contributed to depression
C: Therefore treatment which overlooks such factors would not prove to be as effective – the individual might need to change aspects of their environment + life rather than their thoughts

Question 60

Cognitive behavioural therapy (CBT)

Answer 60

− Why use CBT? – the rationale behind CBT id that thoughts interact with + influence emotions, if thoughts are persistently neg. + irrational they can lead to maladaptive behaviour
− What is CBT? – to encourage ppl to examine beliefs + expectations underlying unhappiness + replace irrational, neg. thoughts with a more pos. adaptive pattern of thinking, therapists + clients work together to set new goals for the clients to bring about more realistic + rational beliefs that are incorporated into their thinking
− What does CBT involve?
→ Cognitive element – the therapist encourages the client to become aware of faulty beliefs that contribute to anxiety or depression or are associated with general dysfunction, this can involve direct questioning e.g. “tell me what you think about …”
→ Behavioural element – the therapist + client decide how the client’s beliefs can be reality tested through experimentation e.g. roleplaying, homework assignments, encouraging the client to recognise the consequences of their faulty cognitions on their behaviour

Question 61

Types of CBT

Answer 61

− REBT (Ellis) – Ellis believed that it’s not the beliefs that lead to self-defeating consequences therefore REBT focuses on encouraging patients to challenge or dispute any self-defeating beliefs replacing them with effective rational beliefs:
→ Logical disputing – self-defeating beliefs do not follow logically from the information available e.g. ‘does thinking in this way make sense?’
→ Empirical disputing – self-defeating beliefs may not be consistent with reality e.g. ‘where is the proof that this belief is accurate?’
→ Pragmatic disputing – emphasises the lack of usefulness of defeating beliefs e.g. ‘how is this belief likely to help me?’
− Beck’s cognitive therapy – mainly used to treat people with depression, encouraging clients to monitor situations where they make neg. assumptions
− Meichenbaum’s stress inoculation therapy (SIT) –a type of CBT used to manage stress

Question 62

Evaluation of CBT: Long-term benefits :)

Answer 62

P: Research has shown the long-term benefits of REBT
E: David et al studied 170 patients suffering from major depressive disorder who were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT (cognitive therapy) or 14 weeks of pharmacotherapy (fluoxetine) – it was found that patients treated with 14 weeks of REBT had better treatment outcomes than those treated with the drug fluoxetine 6 months after the treatment
C: This suggests that REBT is better long-term treatment than drug therapy

Question 63

Evaluation of CBT: Not effective for everyone :(

Answer 63

P: CBT is not effective treatment for everyone
E: CBT appears to be less suitable for: ppl who have high levels of irrational beliefs that are both ridged + resistant to change (Elkin et al), situations where high levels of stress in the individual reflect realistic stressors (i.e. irrational environments) in the person’s life that therapy cannot resolve (Simons et al), ppl who have difficulty concentrating, ppl who have difficulty talking about their inner feelings or those without the verbal skills to do so
C: Therefore there are individual differences in the receptivity towards CBT

Question 64

Evaluation of CBT: Cost-effective :)

Answer 64

P: CBT is considered to be cost-effective
E: CBT tackles the underlying thought processes of patients proving them with sufficient + life-long coping strategies – this is more cost effective than drug treatment where medication must continue even after improvements in mood have been achieved otherwise relapse may occur

Question 65

Evaluation of CBT: Depends on the therapist :(

Answer 65

P: The effectiveness of CBT also very much depends on the therapist
E: e.g. The better trained the therapist the better the therapeutic outcome BUT CBT can be too therapist centred in that therapists may abuse their power of control over patients forcing them into certain ways of thinking + patients can become too dependent on therapists
C: Therefore the success of CBT isn’t just dependent on the commitment + motivation of the client

Question 66

The biological approach to explaining OCD: Genetic explanation

Answer 66

− A popular explanation for mental disorders e.g. OCD is that they may be inherited – this would mean that an individual inherits a specific gene from their parents that relates to the onset of OCD
− The COMP gene:
→ It is related to the production of Catechol-O-methyltransferase (COMP) which is involved in the regaulation of the nurotrabsmutter dopamine
→ All genes come in differnet forms known as alleles + one form of the COMP gene has been found to be more common in patients with OCD – this variation of the gene produces lower actievity of the COMP gene + so results in higher levels of dopamine
− The SERT gene – affects the trasportaion of serotonin creating lower leves of the neurotransmitter
− The diathesis-stress model – it may be the case that there is an interaction bet. genes + environment, the gene may provide a genetic predisposition to developing OCD but this would need to be triggered by another factor perhaps from the environoemt (biological or psychological)

Question 67

The biological approach to explaining OCD: Neural explanation - Abnormal levels of neurotransmitters

Answer 67

− Animal research has shown that when drugs that increase levels of dopamine are administered the animal often displays stereotyped movements that resemble complusice behaviours found in pateints with OCD
− PET scans have shown low levels of serotonin activity in the brains of OCD patients – this is backed up by the fact that drugs that increase the availability of serotonin in the brain (e.g. antidepressants) have been found to reduce the symptoms of OCD
− Evidence for the role of serotonin in OCD comes from Hu – serotonin activity was compared in 169 OCD patients + 253 non-sufferers, it was found that serotonin levels were lower in those with OCD supporting the biological explanation that low levels of serotonin may be implicated in OCD

Question 68

The biological approach to explaining OCD: Neural explanation - Abnormal brain circuits

Answer 68

− PET scans have shown that OCD sufferers can have relatively high levels of activity in the orbital frontal cortex (OFC) – this is a brain associated with higher level thought processes + the conversion of sensory information into thoughts
− This brain area is thought to help initiate activity upon receiving impulses to act + the stop activity when the impulse lessens e.g. you may experience an impulse to wash dirt from your hands + once this is done the impulse to perform the activity stops + so too does that behaviour BUT in the case of an OCD patient it may be the case that there is difficulty switching of these impulses which turn into obsessions (recurring thought e.g. of contamination) + leads to compulsive behaviour
− The caudate nucleus (located in the basal ganglia normally supresses these signals from the orbital frontal cortex (OFC) – however research suggests that the caudate nucleus may be damaged in the OCD brain therefore failing to supress ‘worry signals’ from the orbital frontal cortex which results in the thalamus being alerted creating a ‘worry circuit’ in the brain + causing thought to influence behaviour
− Serotonin + dopamine have been linked to these regions of the frontal lobes:
→ Serotonin is thought to play a key role in the operation of the orbital frontal cortex (OFC) + the caudate nucleus – therefore it is feasible that abnormal levels of serotonin might cause these areas to malfunction
→ Dopamine is the main neurotransmitter of the basal ganglia which is where the caudate nucleus is located + high levels of dopamine are thought to lead to over activity of this region

Question 69

The biological approach to explaining OCD: Neural explanation - Research

Answer 69

− Evidence for the neural explanation of OCD comes from Saxena + Rauch who revived studies of OCD that used PET, fMRI + MRI neuro-imaging techniques to find consistent evidence of an association bet. the orbital frontal cortex + OCD symptoms – this suggests that specific areas + mechanisms of the brain (specifically the OFC) are involved in the disorder
− Evidence from research using PET scans shows increased activity in the orbital frontal cortex (OFC) amongst OCD patients e.g. when a person with a germ obsession holds a dirty cloth – supporting the neural explanation

Question 70

Evaluation of the biological approach to explaining OCD: Research - Grootheest et al’s meta analysis :)

Answer 70

P: Grootheest et al’s menta analysis:
E: Found that in children OCD symptoms are hereditable with genetic influences ranging from 45-65% + in adults OCD symptoms are heritable with genetic influence ranging from 27-47% - these findings suggest that twin studies indicate a genetic component to the transmission of OCD – heritability of OCD appears to be greater in children than adults
C: However the majority of twin studies were not performed in large enough numbers or under methodological conditions sufficient to gather objective data

Question 71

Evaluation of the biological approach to explaining OCD: Not 100% concordance rate bet. MZ twins :(

Answer 71

P: The fact that there is not a 100% concordance rate bet. MZ twins for OCD
E: This suggests that there must be other possible causes of OCD (e.g. environmental) because if it was caused by genetic factors alone then there should be 100% concordance rate
C: Even where OCD is found to run in families it may be learnt as well as possibly inherited as it is difficult to disentangle the role of genes from the environment – also where the condition is thought to run in families it is rarely the case that specific symptoms are inherited e.g. an obsession with dirt which suggests that there is an environmental component to OCD in terms of the symptoms experiences

Question 72

Evaluation of the biological approach to explaining OCD: Issue of cause + effect :(

Answer 72

P: There is an is an issue with cause + effect with regards to the neural explanations
E: We can’t say for sure that the biological factors identified (e.g. low levels of serotonin + abnormal brain circuits) are causing OCD as it could be the case that they are an effect of OCD i.e. OCD reduces serotonin activity
C: This presents issues of cause-effect within these theory + as such reduces its validity

Question 73

Evaluation of the biological approach to explaining OCD: Effectiveness of antidepressants :)

Answer 73

P: It is suggested that low levels of serotonin (a neurotransmitter) are linked to OCD
E: E.g. some anti-depressants increase the availability of serotonin which in turn have been shown to reduce symptoms of OCD (Piggott et al)
C: This seems to strongly suggests that low levels of serotonin are a cause of OCD symptoms – however not all OCD patients respond to drugs that increases levels of serotonin which suggests there may be more than one type of OCD with different biological (or psychological) causes

Question 74

The biological approach to treating OCD: Anti-depressnats - SSRIs

Answer 74

− Low levels of serotonin are implicates in the ‘worry circuit’ so increasing the levels of the neurotransmitter may normalise activity on this part of the brain
− The most commonly used drug to do this is a selective serotonin reuptake inhibitor (SSRI) e.g. Prozac which is generally used as an anti-depressant
− Serotonin is releases into the synapse from the presynaptic neuron + targets receptor sites on the post synaptic neuron, after it has sent the message to the nest neuron is it releases back into the synaptic gap
− Serotonin is normal removed from the synaptic gap by reuptake sites (or transporter sites) on the pre-synaptic neuron
− SSRIs block the serotonin reuptake sites allowing serotonin to remain active in the synapse for longer – this therefore leads to greater availably of serotonin in the synaptic space (to bind to receptor sites)

Question 75

The biological approach to treating OCD: Anti-anxiety - Benzodiazepines (BZs)

Answer 75

− BZ’s slow down the activity of the central nervous system by enhancing the activity of a natural biochemical substance called GABA
− GABA is the body’s natural form of anxiety relief (it has a quietening effect on the brain), GABA acts by:
→ Its reacts with special sites on receiving neuron – it locks into these receptors causing a channel to open that increases the flow of chloride ions into the neuron
→ Chloride ions make it more difficult for the neuron to be stimulated by other neurotransmitters – resulting in a reduction in activity + the person feeling more relaxed

Question 76

Evaluation of the biological approach to treating OCD: Supporting research :)

Answer 76

P: Research suggests that drug therapy specially anti-depressants (SSRIs) are effect on reducing OCD symptoms (both obsessive thoughts + compulsive behaviour)
E: Soomro et al reviewed 17 studies into the use of SSRIs vs placebo treatments on 3,097 OCD patients + found SSRIs to be more effective than placebos at reducing symptoms in the short-term, up to 3 months after treatment
C: This therefore suggests that the patients symptoms improved as a result of the medication elevating levels of serotonin as opposed to the expectation that their symptoms would improve

Question 77

Evaluation of the biological approach to treating OCD: Not actually curing the disorder just treating the symptoms :(

Answer 77

P: It could be argued that drug treatments are not actually curing the disorder – essentially they are just reducing the symptoms to enable the individual to lead a more normal life
E: … which is indicated by the fact that patients often relapse (their symptoms return) within a few weeks if medication is stopped
C: Therefore thus suggests that drugs don’t deal with the root cause of the disorder (‘papering over the cracks’) + so are not necessarily a good long-term treatment option – research had shown that the most effective treatment is to combine a drug treatment with a psychological treatment e.g. CBT

Question 78

Evaluation of the biological approach to treating OCD: Side effects :(

Answer 78

P: A limitation is the side effects that patients may experience
E: SSRIs – nausea, headaches, insomnia, low libido, loss of appetite
BZs – increased aggression, impaired memory + risk of addiction – they should only be prescribed for a maximum of 4 weeks
C: Therefore it may be the case that side effects are severe enough to outweigh the benefits of the drugs i.e. removing the symptoms of OCD

Question 79

Evaluation of the biological approach to treating OCD: Widely used :)

Answer 79

P: Drug treatments are widely used to treat OCD + are often considered more user-friendly + preferably to psychological treatments e.g. CBT
E: Drug treatments require little effort + time + are relatively cheap in comparison to CBT where patients are expected to attend several sessions with a therapists , discuss their thoughts + complete ‘homework’ tasks outside of the therapy session
C: Therefore they are a popular option with patients who lack the time, motivation, commitment + verbal skills needed for CBT – drugs can also reduce anxiety + symptoms sufficiently for CBT to be successfully introduced later

Question 80

Evaluation of the biological approach to treating OCD: Effect depressive symptoms instead of OCD :(

Answer 80

P: Drug treatments may not in fact reduce the obsessive symptoms associated with OCD
E: Instead it may be that case that they lessen depressive symptoms associated with OCD
C: This therefore casts doubt in the effectiveness of drug therapy as a treatment for OCD

Question 81

The biological approach to treating OCD: Psychosurgery

Answer 81

− Psychosurgery is used as a last resort, when patients have failed to respond to drug therapies and are at high risk of suicide.
− It involves destroying specific parts of brain tissue to disrupt the cortico-striatal circuit by the use of radio frequency waves.
− This has an effect on the orbital frontal cortex, the thalamus and the caudate nucleus (which we discussed as one of the biological explanations for OCD).
− Destroying this tissue is often associated with a reduction in symptoms
− It is an invasive treatment that causes the irreversible destruction of brain tissue. Side effects include seizures and increased risk of suicide.

Question 82

The biological approach to treating OCD: Deep brain stimulation (DBS)

Answer 82

− Deep Brain Stimulation (DBS) involves no destruction of tissue, although the wires are permanent.
− Wires are placed in target areas of the brain and attached to a battery.
− When the battery or pulse generator is switched on, it interrupts the target brain circuits in the brain resulting in a reduction of symptoms.