Psychopathology Flashcards
Strength of statistical deviation
All assessments of mental disorders include measurement of how severe their symptoms are compared to the norms. E.g intellectual disability disorder shows hoes there is a place for statically deviation and thus it is a useful part of clinical assessment
What is deviation from social norms
When a person behaves in a way that is different form how they are expected to behave. Social context tells what is ‘correct’ behaviours in particular circumstances
What were the eight criteria Jahoda listed
No symptoms of distress Rational Selfactualise Can cope dress Realistic view of the world Good self esteem and lack of guilt Independent Successfully work, love and enjoy leisure
Limitation of statistical deviation
Unusual characteristics can also be positive and while statistically abnormal they don’t require treatment to return to normal. I.e IQ above 130 is just as unusual but not seen as undesireavle and requiring treatment. Limitation of the concept of statistical deviation and means it should never be used alone to make a diagnosis
Who suggested the critical for ideal mental health
Jahoda
What is deviation from ideal mental health
A different way to look at normality and abnormality is to think about what makes someone normal and psychologically healthy and then identify those who deviate from this ideal
Weakness of deviation from social norms
Culturally relative. Person may label someone from another culture as behaving abnormally using their standards instead of the foreign person. Like hearing voices is acceptable in some cultures but not in the Uk. Creates problems for people from one culture living within a different one
Example of disorder for failing to function adequately
Intellectual disability disorders. As a result of this the person was not able to cope with the demands of everyday living
Example of a deviation from social norm in some cultures
Homosexuality
Example of a statistical deviation
IQS below 70 are statistically abnormal and are diagnosed with intellectual disability disorder (only 2% of people)
What are the three signs Rosenhan and Seligman look for to determine if someone is coping
- when a person doesn’t conform to interpersonal rules like personal space
- when someone experiences distress
- when a persons behabiour is irrational or dangerous
Strength of failure to function adequetly
Attempts to include the experience of the individual. Not entirely satisfactory approach because it’s difficult to assess distress but it acknowledges the experience of the patient is important. Therefore is a useful criterion for sssessing abnormality
Example of the inevitable overlap between deviation from ideal mental health and failure to function adequately
Someone’s inability to keep a job may be a sign of their failure to cope with pressure or as a deviation from the ideal of successful working
Limitation of failure to function adequetly
Subjective judgments. When deciding whether someone is failing to function someone has to judge ehether a patient is distressed or distressing. There are methods to make this objective including checklists such as Global Assessment or Functioning Scale. But the principle remains whether someone has the right to make this judgment.
Strength of deviation from ideal mental health
Covers a broad range of criteria for mental health. Covers most of the reasons someone would seek help from services. The sheer range of factors in Jahodas criteria makes it a good tool for thinking about health
Normal distribution of IQ
Between 85 and 115
Who determined signs to determine if someone is failing to function
Rosenhan and Seligman
Limitation of deviation from ideal mental health
Culturally relative. Some of the ideas in Jahodas classification are specific to Western European and North American cultures. Many collectivist cultures see independence as a bad thing but such traits are typical of individualist cultures and are culturally specific
What is statistical deviation
Defining sbonmormality in terms of statistics - amount of times a behaviour is observed determines whether it’s normal or abnormal
What is failure to function adequately
Inability to cope with everyday life.
What are the four definitions of abnormality
Statistical deviation
Deviation from social norms
Failure to function adequately
Deviation from ideal mental health
Example of a deviation from social norm disorder
Antisocial personality disorder. Formerly psychopathy. They generally lack empathy and ethical behaviour
Strength and weakness of deviation from social norms
Definition had real life application in the case of psychopathy so there is a place for deviation from social norms in thinking about what is normal and abnormal. However there are other factors to consider for example the distress to people with APD Is a failure to function adequetly. So it cns never be the sole reason for defining abnormality
Examples of failing to function adequately
Not being able to hold down a job, maintain a relationship and hygiene
Why are norms specific to the culture we live in
Few behaviours are deemed universally abnormal and therefore definitions relate to cultural context including historical differences
What are the two cognitive approaches to explaining depression
Becks negative triad
Ellis’ ABC model
Why did Beck suggest that some people are more prone to depression
Because of faulty information processing e.g thinking in a flawed way. When depressed we look st the negative aspects of a ditstuion and ignore positives we also tend to blow problems out of proportion and have absolutist thinking
What is a schema
A package of ideas and information developed through experience
What did beck say about depressed people’s schemas
They have negative self-schemas so they interpret all the information about themselves in a negative way
What is the negative triad beck proposed
- negative views of the world
- negative views of the future
- negative views of the self
Strength of Becks theory
Practical application as a therapy. Forms the basis of Cognitivr behavioural therapy. The components of the triad can be easily identified and challenged in CBT. This means a therapist can encourage the patient to test whether the elements of the negative triad are true. Success brcsude it can be used in a successful therapy.
Limitation of becks theory
Does not explain all aspects of depression as it is a complex disorder. Some people are deeply angry and he can’t explain this. Some people suffer buzzare beliefs like Cotard Syndrome (believing they are a zombie). So his theory is not a comprehensive account of depression and cannot always explain all cases of depression
What is the simplified version of Ellis’ ABC MODEL
A stands for activating event
B stands for beliefs
C stands for consewuences
What is an activating event
We get depressed when we experience negative events and there trigger irrational beliefs, events like failing a test may ‘activate’ irrational beliefs
What is the belief we must always succeed called
Musterbation
What is I-can’t-stand-it-itis
The belief that it is a disaster when things don’t go smoothly
Why is the belief that the world must always be fair and just
Utopianism
When an activating event triggers irrational beliefs what happens
There are emotional and behavioural consequences r.g depression
Strength of Ellis’ ABC model
Practical applications in CBT. The idea that by challenging irrational negative beliefs a person can reduce their depression is supported by research - Lipsky.this in turn supports the basic theory because it suggests that the irrational beliefs had some role in depression.
Weakness of ELlis’ ABC model
Cognition may not cause all aspects of depression. Both explanations share the idea that cognition causes depression - closely tied with the concept of cognitive primacy. This is not necessarily always the case. Other theories see emotions stored like physical energy and which emerge some time after their causal event. Casts doubt on the idea that cognitions are always the root cause of depression.
What is cognitive primacy
The idea that emotions are influenced by cognition
Limitation of Ellis model (partial)
Partial explanation. No doubt that some cases of depression follow an activating events. Psychologists call this reactive depression and see it as different from the kind of depression that arises without an obvious cause. This means that the explanation only applies to some kinds of depression and is therefore only a partial explanation.
What is one of the central aims of Becks CBT
Patient and therapist to work together to clarify the patients problems. Also to identify whether there is any negative or irrational thoughts relating to the triad. Once identified the pertinent takes an active role in their own treatment
What is referred to as ‘patient as scientist’ in Becks CBT
When the patient is set homework such as to record when they enjoyed an event or when someone was nice to them
How does recording psoive information about their life help the patient in Becks CBT
In future sessions if patient sassy no one is nice to them the therapist can produce this evidence to prove they are incorrect
What is Ellis’ therapy called
Rational Emotive Behaviour Therapy (REBT)
What does REBT do to the ABC model
Extends it to an ABCDE model - D stands for disbute and E for effect. The technique of REBT is to identify and challenge irrational beliefs
What is the hallmark of REBT
Vigorous argument. A patient may talk about how unlucky their life is and a REBT therapist would identify this as Utopianism and challenge it as an irrational belief
What is an empirical argument
Involves disbuting whether there is evident to support the irrational belief
What is a logical argument
Involved disputing whether the negative thought actually follows from the facts
What is behavioural activation based on
Based on the idea that as individuals become depressed they tend to engage in increasing avoidance and isolation which serves to worsen their symptoms
What is the goal of behavioural activation
The goal of treatment is to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that have been show to improve moods like exercise
What is a strength of CBT
Effective. There is lots of evident to support the effectiveness of CBT for depression. March compared CBT with antidepressant drugs and found 81% of the CBT group improved and 81% of the drugs improved. Shows it is just as effective as medication and helpful along side it as well. Suggest there is a good case for making CBT the first choice of treatment in public health care systems like the NHS
Limitation of CBT
May not work for the most severe cases of depression. Depression can be so severe that some paitients cannot motivate themselves to take on the cognitive work required for CBT. It is possible to treat patients with medication and when they are more alert use CBT. Limitation because t means CBT can’t be used as the sole treatment for depressions
Limitation of CBT (the past)
Some patients want to explore their pasts. One basic principle of CBT is the focus on the patients present and future not their past. But some patients wish to talk about their past experiences linking to their depression. This can be frustrating for some patients and the therapy may ignore an important aspect of the depressed patients experiences
What are the two biological explanations for OCD
Genetic explanations
Neural explanations
What are candidates genes and an example
Specific genes which create a vunerability for OCD e.g 5HT1-D.
How does the gene 5HT1-D do
Implicated in the transmission of serotonin across synapses
What two neurotransmitters have a role in regulating mood
Dopamine
Serotonin
What did Taylor find about OCD
It is polygenetic. There is evidence that up to 230 different genes may be involved in OCD
What is it called when one group of genes cause OCD in one person but a different group causes OCD in another person
Aetiologically heterogenous
What is a disorder
A condition that affects the function of mind or body
What is a gene
They make up chromosomes and consist of DNA which codes the psychical features of an organism and psychological features. Inherited.
What is polygenetic
When several genes are invoked in the cause of a disorder or behaviour
Examples of different types of OCD being the result of particular genetic variations
Hoarding disorder and religious obsession
Strength of genetic explanations for explaining ocd
Supporting evidence that some people are vulnerable to ICD as a result of their genetic makeup. Nestadt found68% of identical twins shared OCD as opposed to 31% of non-identical twins. Strongly supports a genetic influence on OCD.
Limitation of genetic explanations for explaining OCD
Too many candidate genes have been identified. Psychologists have a hard time at pinning down specific genes involved. A reason for this is that it appears several genes are involved and that each genetic variation only increases the risk of OCD by a fraction. Consequence is that a genetic explanation is unlikely to ever be very useful because it provides little predictivr value
What are three neural explanations
Low levels of serotonin
Decision making in the frontal lobe impaired
Parahippocsmous gurus has dysfunctional processing of emotions
How does low levels of serotonin lower mood
Neurotransmitters are responsible for relating information from one neuron to another. If a person has low serotonin then normal transmissions of mood relevant information does not take place and mood and mental processes are affected
Example of disorder associated with impaired decision making
Hoarding disorder
What cause simspired decision making
Abnormal functioning of the lateral sided of the frontal lobes which are responsible for logical thinking and decision making
What is the parahypocampus gurus
Area of the cerebral cortex surrounding the hippocampus involved in memory
How is the parahippocsmous gurus associated with ocd
Evidence suggest this area associated with processing unpleasant emotions functions abnormally in ICD
Limitation of the neural explanations for OCD
Many people who suffer from ICD become depressed. Having two disorders together is called co-morbidity. This depression probably involves disruption to the serotonin system. This leaves us with a logical problem when it comes to the serotonin system as a possible basis for OCD. It could be that the serotonin system is disrupted in patients with OCD because they are depressed
Strength for neural explanations for explaining OCD
Supporting evidenence. Some antidepressants work just on the serotonin level increasing levels of the neurotransmitter. Such drugs are effective in reducing OCD symptoms suggesting that the serotonin system may be involved in OCD. Suggest that serotonin may be a cause of ocd
What is the biological approach to treating OCD about
Drug therapy
What does drug therapy aim to do
Increase or decrease levels of neurotransmitters in the brain or to increase/decrease their activity. Low levels of serotonin are sssocsted with OCD. Therefore drugs work in various ways to increase serotonin in the brain
What are SSRIs
Selective serotonin reuptake inhibitor
How do SSRIs work
Prevents the reabsorotion and breakdown of serotonin in the brain. This increases its levels in the synapse and thus it continues to stimulate the postsynsptuc neuron. This compensates for whatever is wrong with the serotonin system in OCD
What is the typically dosage for an SSRI
For Fluxotine, it is 20mg a day for 3-4 months to impact upon symptoms. This can be increased if needed (to max of 60mg)
How can combining SSRI and CBT help
The drugs reduce a patients emotional symptoms such as feeling doersssing meaning a patient can be more engaged in CBT
What are two alternatives to SSRIS
Tricyclics
SNRIS
What effects do tricyclics have
They are used alongside SSRIS and had the same effect in the serotonin system but the side effects are more severe
Example of a tricyclics
Clomipramine
Why are SNRIS used
When patients don’t respond to SSRIS
How to SNRIS work
Increase levels of serotonin as well as noradrenaline
When did SNRIS start being used
In the last five years
Stench of drug therapy (effective)
Clear evidence for the effectiveness of SSRIS in reducing the severity of OCD symptoms. Typically symptoms reduce for around 70% of people taking SSRIS. Of the remaining 30% drug treatments or combinations of cognitive and biological treatments are effective. So it helps most OCD patients giving them a better quality of life
Strength of drug therapy (cost)
Cost effective and non disruptive. Cheap compared to psychological treatments therefore it is good value for a public health systems like the NHS. You can just take drugs until the symptoms decline and not engage with the hard work of emotional treatments. Many people like drug treatment for this reason
Limitation of drug therapy
Side effects. Some people suffer side effects such as stomach ache, loss of sex drive and blurred vision (although usually temporary). For those taking Clomipramine side effects are more common and more serious. More than 1 in 10 suffer erection problems and weight gain. Such factors reduce effectiveness because people stop taking the medication
What’s a phobia
An irrational fear of an object or a situation
Behavioural characteristics of phobias
Panic - crying screaming running away
Avoidance - can make it hard to go around everyday life
Emotional characteristics of phobias
- anxiety and fear : intense fear leads to anxiety
- unreasonable emotional responses :response to phonic stimulus is widely disproportionate to the threat posed
Example of an emotional response being unreasonable
Aracnophobes resection to a tiny spider
What is the fear of clowns called
Coulnophonia
Cognitive characteristics of phobias
- selective attention to the phobic stimulus ; it is hard to look away or concentrate on anything but the phobic stimulus
- irrational beliefs : believing that something ridiculous will happen
Example of an irrational belief for a phobic stimulus
Social phobes May being if they blush people will think hem weak
What is depression
Mental disorder characterised by low mood and low energy levels
Behavioural haracteristics of depression
- low activity levels resulting in lethargy
- disruption to sleeping and eating: insomnia or hypersomnia and weight loss or gain
Emotional characteristics of depression
- lowered mood: more than just feeling sad it’s described as feeling empty
- anger: extreme anger can lead to agreession and self harm
Cognitive characteristics of depression
Poor concentration: unable to stick with a task like usual or find simple tasks hard. Likely to interfere with their work
- absolutist thinking: black and white thinking when something goes wrong it’s an absolute disaster
What is OCD
A condition characterised by obsession and or compulsive behaviour
Behavioural characteristics for OCD
- compulsions: actions carried out repeatedly like hand washing. Ritualistic to reduce anxiety
- avoidance: avoid situations that trigger anxiety like using handgel to avoid germs
Emotional characteristics of OCD
- anxiety and distress: obsessive thoughts are unpleasant and frieghtening and the anxiety causes massive distress. Urge to repeat behaviour creates ansxiryy
- guilt and disgust: irrational guilt over minor moral issu e or disgust towards oneself or something external like dirt
Cognitive characteristics of OCD
- obsessive thoughts: around 90% of OCD sufferers recurring intrusive thoughts occur
- insight into excessive anxiety: sufferers are aware their thoughts and behaviours are irrational and this is necessary for diagnosis. But they still experience catastrophic thoughts and are hyper vigilant
What is hypervigilance
Being overly aware of an obsession
What is the simplified version of the two process model to explaining phobias (behavioural approach)
Mowrer suggests that phobias are learned by classical conditioning and maintained by operant conditioning
Outline how classical conditioning works for phobias
Learning to associate a neutral stimulus with something that already triggers a fear response (unconditioned response).
This results in the neutral stimulus becoming a conditioned stimulus producing fear which is now the conditioned response
Example of classical conditioning cretinf a phobia
Being bittern by a dog (UCS) which causes pain (UCR) could lead to a fear of dogs. The dog is the neutral stimulus becoming a conditioned one causing a conditioned response of fear following the bite
Study into classical conditioning for phobias
John Watson and Little Albert
Outline the little Albert study
Whenever Albert played with a white rat a loud noise was made. The noise causes a fear response (UCS). The rat (NS) did not create fear until the bang and the rat had been paired together several times.
After conditioning, Albert showed a fear response (CR) every time he came into contact with the rat (now a CS)
Why was Albert scared of a fur coat and white beard as well as the rat
His fear response was generalised to other similar stimuli
When does operant conditioning take place
When our behaviour is reinforced or punished. Both positive reinforcement and negative reinforcement increase the frequency of behaviour:
How does negative reinforcement work in maninting a phobia
An individual produced behaviour that avoids something unpleasant.
When a phobic avoids the phobic stimulus they successfully especade the fear and anxiety hat would have been produced.
This reduction in fear negatively reinforces the avodiance behaviour and the phobia is maintained
Example of how negavtive reinforcment maintains a phobia
If someone has a fear of clowns (coulrophobia) they will avoid the circus and other situations where they may encounter clowns. The relief felt form avoiding them negatively reinforces the phobia and ensures it is maintained rather than confronted
Strength of the two process model
Good explanatory powers. Went beyond Watson and Raynors concept of simple classical condtioning explanation of phobias. Explains how they are maintained overtime and has important implications for therapy. The application to therapy is a strength of the two process model
Weakness of two process model (alternative explanations)
Alternative explanations for avoidance behaviours. More complex phobias like agoraphobia has evidence that at least some avoidance behaviour is motivated more by positive feelings of safety. Explains why some agorophobes can leave the house with a friend but not on their own. Problem for the model which suggests that avoidance is motivated by anxiety reductionS
Weakness of the two process model (incomplete explanation)
There are some aspects of phobias that require further explanations. We acquire phobias of danger in our evolutionary past like snakes. Theory of biological preparedness. This phenomenon is a serious problem for the model because it shows here is more to acquiring phobias that conditioning
What is the theory of biological preparedness
We are innately prepared to fear some things more than others (Seligman)
What are he two behavioural approaches to treating phobias
Systematic desensitisation
What is SD
Systematic desensitisation is a behavioural therapy which aims to gradually reduce anxiety through counterconditioning
What is counterconditioning
Learning a different response to the phobic stimulus
How does SD work
Patient is first taught relaxation techniques such as deep breathing and meditation.
Then they form an anxiety hierarchy with low anxiety stimuli on the bottom and working towards high anxiety on the top.
Relaxation techniques are used at each stage of the hierarchy and as you can’t be relaxed and scared at the same time reciprocal inhibition takes place as one emotion prevents he other.
The conditioned response of fear is substitute by relaxation and the fear response is extinguished.
Theofh classical condtioning the phobic object (Condtioned stimulus) now produces relaxation as a new conditioned response instead of fear.
Treatment is successful when a person can stay relaxed in situations high on the hierarchy.
Example of an anxiety hierarchy
An arachnophobic might have a picture of a spider as their low anxiety hierarchy and have holding a tarantula at the top of their hierarchy
Strength of systematic desensitisation (diverse patients)
Alternatives to SD like flooding are not suitable for some patients. Having learning difficulties can make it very hard for some patients to understand what is happening during flooding or to engage in therapies where you have to express how you are feeling. For these, SD is the most appropriate treatment
Strength of SD (acceptable to patients)
Patients prefer SD over flooding. It does not create he same degree of trauma as flooding and has elements that are pleasant like taking with a. Therapist. Reflected in low refusal rates and low attrition rates.
What is attrition rates
Number of people dropping out of treatment
What is flooding
Involved bombarding the phobic patient with the phobic object without a gradual build up: e.g an arachnophobic recieving flooding treatment may have a large spider crawl over their hand until they can relax
How does flooding stop the phobic responses quickly
Without the option or avoidance behaviour the patient quickly learns that the phobic object is harmless through the exhaustion of their fear response. This is known as extinction
What is extinction
The disappearance of W learned response when stimuli stop being paired or no reinforcement occurs
Is flooding unethical
It’s not unethical but it is unpleasant so it is important patients give informed consent and must be fully prepared and know what to expect
Strength of flooding
Cost effective. Studies comparing flooding to cognitive therapies found flooding is highly effective and quicker than alternatives. This is astern because it means patients are free of their symptoms as soon as possible and treatment is cheaper
Weakness of flooding
Traumatic for patients. T is not unethical but patients are often unwilling to see it through to the end. Ultimately it means that treatment is not effective and that time and money are wasted preparing patients only to have them refuse to start or complete treatments
