Psychopathology Flashcards
1
Q
What is psychopathology?
A
The scientific study of mental disorders
2
Q
What is statistical infrequency?
A
Any behaviour that is statistically infrequent (rare) so found in very few people
3
Q
What is deviation from social norm?
A
Not doing what the majority of society do, so someone who deviates from social norms
4
Q
What is failure to function adequately?
A
Not being able to function adequately, so for example not being able to hold down a job properly
5
Q
What is deviation what ideal mental health?
A
Not having ideal mental health, so for example seeing things that aren’t real
6
Q
Give an example of Statistical infrequency
A
Intellectual disorder requires an IQ in the bottom 2% of the population.
7
Q
Evaluation of Statistical frequency: Sometimes the definition is appropriate
A
- the definition does have a real life application in the diagnosis of intellectual disability disorder
- e.g an intellectual disability is calculated in terms of the normal intellectual disability using standard deviation as a cut off point.
- any individual who’s IQ is more than two standard deviations below the mean is judged as having a mental disorder
8
Q
Evaluation of statistical frequency: Some statistically rare behaviour is desirable
A
DESIRABLE-Very few people have an IQ of over 150, yet we would not want to suggest that having such a high IQ is undesirable
UNDESIRABLE-Depresson
This is a problem as we are unable to distinguish between desirable and undesirable
9
Q
Evaluation of Statistical frequency: Cultural relativism , Behaviours may be be statistically rare in some cultures but not in others
A
- relative to the group of people around them
- e.g one of the symptoms of Schizophrenia is claiming to hear voices. This experience is common in some cultures
- the model is culturally relative
10
Q
Evaluation of deviation from social norms: social norms vary as times change
A
- what is socially acceptable now may not have been socially acceptable 50 years ago
- e.g today homosexuality is acceptable but in the past it was included under sexual and gender indentity disorders in the DSM
- if we use this method we base the diagnosis on whatever the current social moral is. This then allows mental health professionals to classify as mental ill those who transgress against social attitudes
- Thomas Szasz claimed that the concept of mental illness was simply a way to exclude non-conformists from society.
11
Q
Evaluation of deviation from social norms: However the definition does distinguish between undesirable and desirable behaviour
A
- the model takes into account the effect that behaviour has on others
- deviance is defined in terms of transgression of social rules and social rules are ideally established in order to help people to live together
- according to this definition deviating from social norms damages others and therefore have an impact on our mental wellbeing
12
Q
Evaluation of deviation from social norms: making judgements on deviance is often to related on the context of a behaviour
A
- a person on a beach wearing next to nothing is regarded as normal, whereas in a classroom this outfit would be an indication of a mental disorder
- not a line between eccentricity and abnormal deviation
- shouting loudly and persistently is deviant behaviour but not evidence of a mental disturbance unless its excessive
- cannot on its own offer a complete definition of abnormality because it is inevitably related to context.
13
Q
Evaluation of failure to function adequately: Who judges?- in order to determine failure to function adequately someone needs decide if this is actually the case
A
- it may be that the patient is experiencing personal distress, e.g not being able to eat regularly
- the patient may feel distressed and may understand that this is undesirable
- on the other hand it may be that the individual is quite content with the situation and are unaware that they are not coping
- it is others who are uncomfortable and judge the behaviour as abnormal
e. g some schizophrenics are dangerous, as in the case of Peter Sutcliffe (the Yorkshire ripper) - therefore it depends on who is making the judgement
14
Q
Evaluation of failure to function adequately : some dysfunctional behaviours can actually be quite functional for the individual
A
- some mental disorders such as eating disorders or depression may lead to extra attention for the individual.
- such attention is rewarding and quite functional.
- e.g transvestitism is classed as a dysfunctional disorder but many would regard it as a perfectly functional behaviour.
15
Q
Evaluation of failure to function adequately: the definition is related to cultural ideas about how ones life should be lived
A
- criterion is likely to result in different diagnostics when applied to people from different cultures because they vary
- this may explain why the lower-class are more often diagnosed with mental disorders, because their lifestyles are different to the dominant culture, this may lead to a judgement of failure to function adequately
- however the higher level of diagnosis may also be to the mental illness caused by inequality and poverty
16
Q
Evaluation of deviation from ideal mental health: The criteria are hard to measure objectively.
A
- -it is hard to measure concepts such as the extent to which someones personal growth has developed
- interesting concept but is unusable when it comes to defining abnormality(according to the criteria most of us are abnormal)
- how many of the criteria do we need to be lacking before we can be judged as abnormal?
- may be interesting but it is not practical
17
Q
Evaluation of deviation from ideal mental health:It is also very difficult to fulfil these remaining criteria
A
- Jahoda presents them as ideal criteria and they certainly are
- according to this criteria most of us are abnormal
- how many do we need to lack before we are classed as abnormal?
- definiton is not clear on the ‘extent’
18
Q
Evaluation of deviation from ideal mental health: The definition originates in America and is based on Western ideas of mental health
A
- if we apply these criteria to people from non western or even non-middle class social groups we will probably find a higher incident of abnormality
- self-actualisation is relevant to members of individualist cultures but not collectivist cultures where they strive for greater good of the country
- makes the definition culture bound and less useful
19
Q
Evaluation of deviation from ideal mental health: However it is a positive approach to abnormality as it focuses on what is desirable rather than undesirable
A
- although Jahoda’s ideas were never taken up by mental health professionals, the ideas have had some influence and are in accord with the ‘positive psychology’ movement
- the definition plays a role in developing a persons well being and satisfaction in life rather than identifying actual mental disorders
20
Q
What were the 6 criteria that Jahoda proposed?
A
1.) SELF-ATTITUDES
having high self-esteem and a strong sense of identity
2.)PERSONAL GROWTH AND SELF ACTUALISATION
the extent to which an individual develops to their their own capabilities
3.)INTEGRATION
such as being able to cope with stressful situations
4.)AUTONOMY
being independent and self-regulating
5.)Have an ACCURATE perception of reality
6.)MASTERY OF THE ENVIRONMENT
Ability to love, function at work and adjust to new situations
21
Q
Give an example of failure to function adequately
A
- The DSM includes an ability to function called WHODAS. This includes 6 sections
e. g self care. Individuals rate them them on a scale of 1-5 and are given an overall score out of 180. - This gives a quantitive measure of functioning
22
Q
What is a phobia?
A
- an anxiety disorder which interferes with daily living
- an instance of irrational fear that produces conscious avoidance of the feared object or situation
23
Q
What are the two stages used to explain phobias?
A
1st stage: -classical conditioning (learning by association)-little Albert -how phobias begin 2nd stage: -operant conditioning -how phobias are maintained
24
Q
Describe the two stage process on the acquisition of phobias
A
-a phobia is initially acquired through association
-the neutral stimulus produces a fear response because it has become associated with the UCS.
In this way the neutral stimulus because the conditioned stimulus.
HOWEVER this doesn’t explain why individuals continue to fearful, nor does it explain why individuals avoid the feared object
-the next step step involves operant conditioning
operant conditioning explains how phobias are maintained. Behaviour that is regarded is more likely to be repeated. The avoidance of the phobic stimulus reduces fear and anxiety and therefore is reinforcing.
Negative reinforcement= you are going to keep avoiding the phobic stimulus
A phobia can also be maintained through positive reinforcement- the attention that you receive when scared is reinforcing
25
Describe the emotional characteristics of phobias.
- fear that is marked
- likely to be excessive and unreasonable , coupled with feelings of anxiety and panic
- out of proportion to the actual danger posed
26
Describe the behavioural characteristics of phobias.
- avoidance
- the opposite response is to freeze or even faint
- 'freezing' is an adaptive response because the predator may think the prey is dead
- avoidance may interfere with the persons social activities
27
Describe the cognitive characteristics of phobias.
- thought processes
- irrational nature of the persons thinking
- resistance to rational arguments (a person with a fear of flying is not helped by arguments that flying is actually the safest form of transport)
- the person realises their fear is unreasonable, separates people from a delusional mental illness such as schizophrenia where they are unaware.
28
Describe the emotional characteristics of depression
- sadness
| - loss of interest or pleasure in normal activities
29
Describe the behavioural characteristics of depression
- changes in activity levels (either reduced or inc.) e.g sleeping (insomnia)
- reduced energy
30
Describe the cognitive characteristics of depression
- irrational thinking
| - bias towards seeing the negative
31
What are the limitations of Johoda's 6 criteria?
- criteria is hard to measure objectively
- it sets out an unrealistically high criteria for mental health
- cultural issues (collectivist/individualist cultures?)
32
What is cultural relativism?
Definition based on Western values- (independence, personal growth) but not all cultures share the same values
33
What is an individualist culture?
-Focus on the person and their achievements e.g USA, Europe
34
What is a collectivist culture?
-Focus on the group and the well being of the group e.g China, India, Japan
35
What is a phobia?
- An anxiety disorder which interferes with daily living
| - It is an instance of irrational fear that produces conscious avoidance of the feared object or situation
36
A03 for behavioural explanations of phobias: strengths
- The evidence has good explanatory power and evidence to support it
- Watson and Rayner demonstrated that emotional responses could be learnt through classical conditioning, their subject was an 11 month old boy called little Albert
- At the beginning of the study he showed little response to white furry objects i.e they were neutral stimuli, they the created a conditioned response. When Albert reached for the rat they struck a bar to startle him, after this whenever he saw furry objects he began to cry, they had conditioned a fear response
- Sue et al found that people with phobias often do recall a specific incident when their phobia appeared
37
A03 for behavioural explanations of phobias: the explanation has led to successful treatment
- What has been learnt can be unlearnt through systematic desensitisation, where a fear response is replaced with relaxation (counter conditioning). This has been found to be highly effective in treating specific phobias such as fear of birds or spiders
- As the therapy is built on behavioural principles, its effectiveness on those principles are correct. However the therapy form is less successful in treating social phobias which have a cognitive element e.g having unpleasant thoughts about social situations suggesting that cognitive factors play. role too
38
A03 for behavioural explanations of phobias: However evidence exists which challenge the behavioural explanation of phobias
- According to the two process model, an association between a neutral stimulus and a fearful experience will result in a phobia
- However research such as Di Nardo et al has found that not everyone that is bitten by a dog becomes phobic of them.
- This could be explained by the diathesis stress model, this proposes that we inherit a genetic vulnerability for developing mental disorders.
- However a disorder will only manifest itself if triggered by a life event such as being bitten by a dog. So a dog bite would only lead to a phobia in those people with such a vulnerability
- Menzies and Clarke found that only 2% of the water-phobic children claimed to have a direct conditioning experience with water
- This suggests that the learning explanation can not offer a full explanation as classical conditioning doesn't explain how all people attain a phobia, nor why phobias develop in the absence of a negative learning experience
39
A03 for behavioural explanations of phobias: Alternative explanations for phobias exist
- the fact that phobias do not always develop after a traumatic incident may be explained in terms of biological preparedness
- Martin Seligman argued that animals (including Humans) are genetically programmed to rapidly learn an association between potentially life threatening stimuli and fear
- The stimuli are referred to as ancient fears-things that would have been dangerous in our evolutionary past e.g snakes
- It would have been adaptive to readily learn to avoid stimuli
- This would explain why people are much less likely to develop fears of modern objects such as toasters which are more of a threat than spiders
- this explains why Bregman failed to condition a fear response in infants aged 8 to 16 months by pairing a large bell with wooden blocks. It may be that fear responses are learnt with living animals
- behavioural explanations can not be used alone to explain the development of phobias
40
What is CBT
Cognitive behavioural therapy
41
Give examples of CBT
Depression - exposure therapy: systematic desensitisation/flooding
42
What is systematic desensitisation?
-Aims to extinguish an undesirable behaviour, fear, by replacing it with a more desirable one, relaxation
43
Systematic desensitisation is a form of ....?
| -what is reciprocal inhibition
Counter conditioning
| -reciprocal inhibition is counter conditioning as we cannot fee fear and relaxation at the same time
44
How does systematic desensitisation work?
- It is a step by step approach (gradual exposure)
- the client learns relaxation techniques
- the client works out a hierarchy of fear from the least frightening to the most frightening
- the client works through the hierarchy learning to use relaxation techniques in the presence of the feared object
- they do not progress up the hierarchy until relaxation has been achieved at each stage
- eventually the fear is replaced with relaxation
45
What is depression?
- A mood disorder where an individual feels sad and/or lacks interest in their usual activities
- A formal diagnosis of major depression requires at least 5 symptoms and must include either sadness or loss of interest and pleasure to normal activities
46
What are the emotional characteristics of depression?
- sadness
| - loss of interest or pleasure in normal activities
47
What are the behavioural characteristics of depression?
- changes in activity level (either reduced or increased) e.g e.g sleeping (insomnia), eating or socialising
- reduced energy
48
What are the cognitive characteristics of depression?
- Irrational thinking
| - Bias towards seeing the negative
49
What are the two cognitive explanations for depression?
1. ) Becks theory
| 2. )Ellis-ABC model
50
What is depression caused by?
Distorted or irrational thinking
51
In depression,what are our experiences influenced by?
- selective attention
| - the way we 'filter' information and think about events and ourselves
52
How does Beck explain depression in cognitive terms?
Faulty information processing causes selective attention to the negative aspects of situations
53
Describe Becks cognitive explanation of depression
Depressed people often:
- acquire negative schemas during childhood e.g parental rejection, bullying, teacher criticism, loss of a loved one
- such schemas affect how we interpret any new information
- they are activated whenever we encounter situations that resemble the original situations we learned them in
e. g
* rejection split- old fears of rejection will come to the surface
* uni exam-fear of failing in secondary school
54
Give examples of negative schemas
- All or nothing e.g must be good at everything or I am not worthy
- Labelling (im such an idiot)
- Over generalisation (one thing goes wrong=things always go wrong)
55
What is Becks negative triad?
Where negative shemas and cognitive biases cause us to see the world and ourselves in a very negative light.
56
Describe the three points in Beck's triad
1. ) View of self ('I'm useless'
2. )View of world (your experiences, other people)
3. )View of future (e.g things will never change)
57
Depressed people often...?
- acquire negative schemas during childhood
- negative schemas lead to cognitive biases in thinking
- together they maintain a negative triad
58
What are the basic principles of Ellis's ABC model?
Similar to Beck's theory: depression is caused by irrational beliefs, however the model he proposes is different to Becks
59
What does the 'A, B and the C' stand for in Ellis's ABC model?
A= Activating
B=Beliefs
C=Consequences
60
Describe Activating in Ellis's ABC model
Activating an event (something happens, e.g a person gets fired from their job)
61
Describe Beliefs in Ellis's ABC model
Beliefs about this event e.g rational "its just a job role change" or irrational "I'm not good enough"
62
Describe Consequences in Ellis's ABC model
Consequences of those beliefs
- rational beliefs lead to healthy emotions/ behaviour
- irrational beliefs lead to unhealthy emotions e.g depression
63
Describe Ellis's 'mustabatory' thinking
- the source of irrational beliefs lies in a rigid belief that certain things must be true in order for us to be happy
- I must be approved of people I find important
- I must do well or I am worthless
- The world must give me happiness or I am worthless
- People must live up to my expectations
- Such 'musts' need to be challenged in order for mental happiness to prevail
64
Negative schemas and cognitive biases: Lewinson
- Studied teenagers without depression
- He measured their thinking style to determine if it was rational or irrational
- A year later he measured the teenagers again and found that the teenagers who subsequently had developed depression were those with the more irrational thinking style
65
A03: Cognitive approach of abnormality: One problem with the model is cause and effect
- one problem with the model is cause and effect
- that is, it could be faulty thinking that may be the effect of a mental disorder, rather than the cause of it
- for example an individual with depression may develop negative thinking because he is depressed rather than the other way round
- it could be that the original disorder is caused by biochemical factors such as the under activity of neurotransmitters, with negative thinking being the effect.
66
A03: Cognitive approach of abnormality: Another objection to the cognitive model is that it blames abnormality on the patient and assumes they are responsible
- Another objection to the cognitive model is that it blames abnormality on the patient and assumes they are responsible
- Often the model overlooks situational factors. That is, events in the life of the individual which they cannot control
- For example, it may not consider how life events or family problems may have contributed to the mental disorder
- This is because the cognitive model assumes the disorder is simply in the mind of the patient, and that recovery lies in changing that-rather than what is in the environment
67
A03: Cognitive approach of abnormality: A positive aspect of the model is that it is supported by research studies
- A positive aspect of the model is that it is supported by research studies
- E.g Gustafson conducted a study which found that irrational thinking processes were displayed by many people with psychological disorders such as anxiety disorders and depression
- This shows that people suffering from mental disorders do exhibit faulty thought patterns
- Thus, there is evidence to support the main underlying assumption of the cognitive model of abnormality
68
A03: Cognitive approach of abnormality: The model has also led to the development of successful therapies for treating disorders
- The model has also led to the development of successful therapies for treating disorders
- These therapies concentrate on challenging and changing the faulty thought patterns of their patients
- The focus has been shown to be much more effective than concentrating on immediate behaviours (as the behavioural model would) or deeper meaning (as the psychodynamic model would)
- As such, this lends support to the fact that abnormal behaviours are the result of faulty thought patterns, as opposed to conditioning (behavioural model) or unconscious drives (psychodynamic model)
69
What is Flooding?
- immediate full exposure to the feared stimulus (no gradual exposure)
- prevention of avoidance (cannot escape, but the exposure happens in a safe environment)
- exposure doesn't stop until they are calm, anxiety has receded and fear is extinguished
70
What idea is flooding based upon?
- The idea hat anxiety will peak and eventually subside
e. g a person with a spider phobia would have a large spider crawl over their hand for an extended period. Eventually the anxiety levels will come down.
71
How does flooding work?
* Quicker than SD-maybe because without the option of avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless
* based on principles of classical conditioning
* conditioned stimulus occurs without the unconditioned response
e. g a dog is encountered without you being bitten
* leads to extinction (the CS happens without the CR)
* usually lasts 2-3 hours
* adrenaline peaks during this time and starts to decrease
* A new stimulus response link is learned between the feared stimulus and relaxation
72
Why might systematic desensitisation be more effective than flooding ?
- It allows people to make progress in small steps, in their own time rather than that required by the therapist- client in control
- SD generally has low attrition rates and high completion rates because the gradual progress of the therapy allows respite, the relaxation is pleasant
- SD may be more successful for certain individuals e.g children, people with certain health conditions
- SD may be less traumatic, leading to more people completing the treatment, and suitable for a wider range of clients
73
A03 for systematic desensitisation- SD is shown to be effective. Research has show that SD is successful for a range of phobic disorders
- McGrath et al reported that about 75% of patients with phobias responded to SD
- The key to success appears to lie with actual contact with the feared stimulus, so are more successful than ones just using pictures or imagining the feared stimulus
- Often a number of different exposure techniques are used, e.g modelling where the patient watches someone else who is coping well with the feared stimulus
74
A03 for systematic desensitisation- However SD is not appropriate for all phobias
- Ohman et al suggests that SD may not be effective in treating phobias that have an underlying evolutionary survival component (e.g fear of dark, heights, dangerous animals) than in treating phobias which have been acquired as a result of personal experience
- This suggests that SD cannot be used to treat all phobias
75
A03 for systematic desensitisation: SD can be used on a diverse range of patients
- e.g people with learning difficulties
- they may not be able to understand what is happening during flooding or be able to engage with cognitive therapies that require the ability to reflect on what you ate thinking. Foe the patients SD is most probably the most suitable treatment
- this suggests that SD is better than flooding as this is less intense and overwhelming
76
A03 for systematic desensitisation: Symptom substitution may occur
- Behavioural therapies may not work with certain phobias because the symptoms are only the tip of the iceberg
- If the symptoms are remove the cause still remains and the symptoms will only resurface, possibly in another form, this is symptom substitution
- E.g according to the psychodynamic approach phobias develop because of projection
- Freud recorded the case of little Hans who developed a phobia of horses. The boys problem was an intense envy of his father but he could not express this directly and the anxiety was projected onto the horse. The phobia was cured when he accepted his feelings about his father. If the therapist had treated his horse phobia the underlying problem might have remained and resurfaced elsewhere
- Suggests that SD and flooding cannot be relied upon solely to be a treatment of all phobias
77
What is cognitive behavioural therapy?
A psychological therapy that combines behavioural and cognitive approaches
78
What are the 5 principles that CBT is based on?
1. ) Identify irrational thinking (clinical interview, diary keeping)
2. )Challenge these thoughts-thought questioning
3. )Replace irrational thoughts with rational ones
4. )Do behavioural tasks for homework to back up changed beliefs
5. )Learn new techniques like 'thought stopping' or 'self talk'
79
How are irrational thoughts challenged?
1. ) By disputing/ questioning
2. )By setting homework
3. )By monitoring their own thinking
80
CBT: what are the three different types of disputing?
a. )Empirical disputing
b. )Logical disputing
c. )Pragmatic disputing
81
What is Empirical disputing?
Asking for evidence for those irrational beliefs
| e.g can you remember a situation were this did/did not happen
82
What is Logical disputing?
Does it make sense to think like this
83
What is pragmatic disputing?
Is this way of thinking helpful to you?
84
How are irrational thoughts challenged when you set homework?
- Testing irrational beliefs against reality (e.g show them that they can do things they didn't think they could)
- Putting new, more rational beliefs into practice
85
How does monitoring their own thinking challenge irrational thoughts?
Becoming aware of when their thinking becomes distorted
86
Describe the therapist-client relationship
- Therapists provide clients with unconditional positive regard (i.e respect and appreciation regardless of what the client does or says)
- This is important as much of the therapy involves convincing the client of their value as a human being as if they are feeling worthless, they are less likely to change their beliefs
87
Give two examples of CBT
1. ) Becks cognitive therapy
- focuses in the negative beliefs in the cognitive triad (self, world, future)
2. ) Ellis's REBT (rational, emotive, behavioural therapy)
- challenges the negative beliefs in the ABC model
- disputing these are replacing them with more rational beliefs
88
A03 of CBT: A strength of CBT is that it is supported by evidence supporting its effectiveness
-e.g Ellis claimed 90% success rates for patients completing an average 27 sessions.
-This is further supported by Favar who studied 40 patients. Patients were randomly allocated to either:
1.) CBT+ Drugs
2.)Drugs only
75% of the CBT and drug group were symptom free 2 years later versus 25% of the drug only group
-This suggests CBT may be longer lasting
-However Ellis did also realise that therapy was not always effective and suggested that this was because some clients did not put their revised beliefs into action
89
A03 of CBT: Changing behaviour e.g through homework tasks has shown to be effective
- Research shows that exercise can be beneficial in alleviating symptoms
- Babyak et al studied 156 adult volunteers diagnosed with major depressive disorder
- They were randomly assigned to a 4 month course of aerobic exercise, drug treatment or a combination of the 2
- 6 months after those in the exercise group had significantly lower relapse rates than those in the medication group
- This shows that behaviour such as exercise may have a longer lasting effect than drugs on attitudes and thinking
90
A03 of CBT: A weakness of CBT is that individual differences influence it's effectiveness
- CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change. CBT also appears to be less suitable in situations where high levels of stress in the individual reflect realistic stressors in the persons life that therapy cannot solve.
- Ellis also explained a possible lack of success in terms of suitability, some people simply to not want that direct sort of advice that CBT practitioners tend to dispense . They prefer too share their worries with a therapist without getting involved in the cognitive effort that is associated with recovery
91
A03 of CBT: CBT is effective but requires effort and commitment from the person undergoing it
- The most popular treatment for depression is the use of anti-depressants such as SSRI's. Drug therapies have the advantage of requiring less effort on the part of the client.
- Note that Ellis required 27 sessions of REBT which is a lot of commitment
- Drug therapy could be used in conjunction with psychotherapy such a CBT, this may be useful because a distressed client may be unable to focus on the demand of CBT but the drug treatment enables them to cope better
- The review by Cuijipers et al found that CBT was especially effective if it is used in conjunction with drug therapy
- Both CBT and drugs have different roles, the use of these is dependant on the person
92
What is OCD?
Obsessive compulsive disorder
93
What is the definition of OCD?
An anxiety disorder where anxiety arrives from:
-obsessions (persist thoughts)
-compulsions (repetitive behaviours such as hand washing, counting, praying)
People believe that their anxiety will reduce by performing these actions
94
What are the emotional characteristics of OCD?
- high levels of anxiety and distress
| - shame (person knows their behaviour/thoughts are excessive
95
What are the behavioural characteristics of OCD?
- compulsive behaviours
- repetitive (e.g keep washing hands)
- reducing anxiety (temporary relief until the thoughts start coming back)
- avoidance
96
What are the cognitive characteristics of OCD?
- obsessive thoughts
- recurrent (keep hearing the same thoughts)
- intrusive (can't stop them)
- uncontrollable (creates anxiety)
- people are aware their obsessions and compulsions are irrational
97
What is the difference between obsessions and compulsions?
Obsessions are thoughts (in your mind) whereas compulsions are behaviours (what you do)
98
What are the two biological explanations to explaining OCD
- Genetic explanations
| - Neural explanations
99
What is the genetic explanation towards OCD?
A persons vulnerability may be affected by their genetic makeup:
- COMT gene
- SERT gene
100
What is the neural explanation towards OCD?
A persons vulnerability may be affected by:
- their brain functioning
- abnormal levels of neurotransmitters
- dopamine and serotonin
- abnormal brain circuits
- the worry circuit
101
How do psychologists study genetic influences on behaviour?
1. ) Family studies- we inherit behaviours from parents, but may be down to nurture, not nature, of behaviours are similar
2. )Twin studies-compare MZ and DZ twins, if concordance rates are higher for MZ then DZ= a genetic influence on their behaviour
3. )Adoption studies-separate nature and nurture, if a child is more similar to their biological parent than their adopted one= genetic influence
102
How do Genes affect OCD?
A pre-disposition to OCD may be inherited
103
Where may we gain information from a pre-disposition to OCD?
- family and twin studies
| - brain scans
104
What sort of condition is OCD?
| -how many genes are involved
- a polygenic condition
| - a number of genes (230 genes)
105
What 2 main genes are involved causing OCD
- seratonin
| - dopamine
106
How does the SERT gene affect OCD?
- the SERT genes affects the transport of serotonin
- OCD may be caused by a mutation of this gene
- the mutation causes an increase in the re-uptake of serotonin
- this in turn causes lower levels of serotonin in the synaptic gap
- someone who does not have a mutated SERT gene.
107
How does the COMT gene affect OCD?
- regulates the production of dopamine
- people with OCD are more likely to have a particular mutation of this gene
- however this mutation has the opposite effect of the SERT mutation
- a mutated variation of the COMT gene causes lower levels of the COMT gene and higher levels of dopamine
108
Describe the basis of Neural explanations
Abnormal levels of neurotransmitters and abnormal brain circuits
109
Neural explanations: Describe how abnormal levels of Serotonin may be the cause of OCD?
- abnormalities, or the imbalance in the neurotransmitter serotonin could also be related to OCD
- Seratonin is involved in regulating mood- OCD patients have low levels of serotonin, wether low levels of Serotonin causes OCD is unknown
- all that is known is that high levels of anxiety is associated with low levels of serotonin, anxiety is an emotional characteristic of OCD
110
Neural explanations: Describe how abnormal levels of dopamine may be the cause of OCD
- dopamine is abnormally high in individuals with OCD
- dopamine is involved in attention and concentration. High levels of dopamine may make people unable to stop focussing on obsessive thoughts and repetitive behaviours
111
How do neurotransmitters affect the functioning of the orbitfrontal cortex?
It is thought that serotonin and other neurotransmitters help the functioning of the orbitofrontal cortex and the caudate nucleus. Low levels of serotonin may cause the OFC and caudate nucleus to malfunction
112
What 3 things does the orbitofrontal cortex circuit include?
- orbitofrontal cortex
- caudate nucleus
- thalamus
113
Describe how abnormal brain circuits cause OCD
- the OFC is involved in decision making and regulation of emotion
- when this part of the brain is activated, you become aware of your primal instincts and your brain makes a decision on how to appropriately address this impulse
- the caudate nucleus acts as a filter, screening out irrelevant or unimportant pulses
- the most important ones are passed on to the thalamus, the individual is driven to think more about them and take action
- the thalamus plays a role in controlling the motor systems of the brain which are responsible for voluntary movements
- in a person with OCD minor worry signals from the OFC are suppressed by the caudate nucleus and so never reach the thalamus. However if the caudate nucleus is damaged it fails to suppress minor worry signals and the thalamus is affected, which in turn sends signals back to the OFC which becomes over-active
- the whole thing creates a worry circuit
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What is the OFC involved in?
Decision making and regulation of emotion
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What is the role of the caudate nucleus?
It acts as a filter, screening out irrelevant or unimportant pulses
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What is part of the thalamus's role?
-controlling the motor systems of the brain which are responsible for voluntary movements
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Give an example of how abnormal brain circuits play a part in daily life
- after a visit to the bathroom your primal instinct to survive is by avoiding germs is brought to your attention
- you make the decision to remove any germs you have encountered by washing your hands
- once you have performed the appropriate behaviour, the OFC reduces in action and you go about your day
- however if you have OCD your brain can get stuck in a worry circuit.
- this means the obsessions and compulsions continue, leading you to wash your hands again and again
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Describe the three way system of brain circuits
1. )OFC sends worry signals to thalamus
2. )Caudate nucleus monitors signals
3. )Thalamus sends filtered version of danger back
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A03: Describe how Szechtman et al provides support for abnormal levels of neurotransmitters in OCD
High doses of drugs that enhance dopamine induce movements resembling compulsive behaviours found in OCD patients (animal studies)
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A03: Describe how Pigott et al provides support for abnormal levels of neurotransmitters in OCD
Antidepressant drugs that increase serotonin levels can reduce OCD symptoms
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A03: Genetic explanations of OCD
-the role of genetic factors is supported by family studies
(Ozaki et al)
Mutation of the SERT gene was found in two unrelated families where 6/7 family members had OCD
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A03: Genetic explanations of OCD
-the role of genetic factors is supported by family studies
(Nestadt et al)
Compared 2 groups:
*Group 1- 80 patients with OCD and 343 of their 1st degree relatives
*Group 2- Control group without mental illness and their relatives
People with 1st degree relatives who had OCD had a 5x greater risk of OCD
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A03: Genetic explanations of OCD: Billett et al carried out a meta-analysis of 14 twin studies
-MZ (identical) twins are more than twice as likely to develop OCD if their co-twin had it than was the case for DZ (non-identical) twins
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A03: Genetic explanations of OCD: Criticisms: Concordance rates never 100%
- Concordance rates for twins studies are generally high compare with other disorders, however concordance rates are never 100%
- This suggests that other factors such as environment are involved in the development of OCD and that genetic factors can not offer a full explanation
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A03: Genetic explanations of OCD: Criticisms: MZ twins may be treated more similarly
-MZ twins may be treated more similarly because they look the same, this is a problem for twin studies and the genetic explanation because the higher MZ rates for MZ twins might be caused by their similar environment rather than their similar genes
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A03: Genetic explanations of OCD: Criticisms: there are no specific genes unique to OCD
- There are no specific genes unique to OCD, the genes in question just simply increase the risk of obsessive type behaviours seen in Tourettes, Autism and Anorexia
- Therefore genes only create a vulnerability (a diathesis) for OCD aswell as other conditions such as depression
- Other factors (stressors) affect which condition develops and wether it develops
- Therefore someone could possess the COMT or SERT gene mutations and suffer no ill effects
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Explain the diathesis stress model
```
Diathesis= biological vulnerability
Stress= nature and nurture interact, environmental stress may trigger the vulnerability
```
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A03: Neural explanations: Support for the orbitofrontal cortex circuit
- Menzies used MRI to produce images images of brain activity in OCD patients and their close family without OCD, and also a group of unrelated healthy people
- OCD patients and their close relatives had reduced grey matter in the OFC (cell body=grey)
- this supports the fact that anatomical differences are inherited and these may lead to OCD in certain individuals
- however, the fact that close members did not develop OCD suggests other factors play a role in the development of OCD such as environmental factors (bad experiences)
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A03: Criticisms for biological explanations: Alternative explanations for OCD do exist and provide a challenge to the biological explanations.
The two process model (behavioural approach ) can be applied to OCD
1.) Initial learning occurs when a neutral stimulus (e.g dirt) is associated with anxiety
2.) An association is maintained through negative reinforcement (avoiding the thing that provokes anxiety)
3.)An obsession is now formed (e.g with dirt) and compulsive behaviours are learnt (e.g hand washing) as these will appear to reduce anxiety
As such OCD can be explained purely in terms of environmental factors rather than biological factors
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The two process model (behavioural approach ) can be applied to OCD: The biological explanations are further challenged by behavioural treatment
- Both exposure and response-prevention therapy (similar to systematic desensitisation)
- 60-90% of OCD patients were found to improve considerably with this form of therapy.
- This suggests the cause may not be entirely biological but also linked to maladaptive learning
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Drug therapy: Give two examples of a antidepressants that reduce OCD
1. ) SSRI's
| 2. )Tricyclics
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Give an example of SSRI's
Prozac
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Give an example of tricyclics
Clomipramine
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What does SSRI stand for?
Selective serotonin re-uptake inhibitor
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What are the advantages of SSRI's over tricyclics?
fewer side effects
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Why are SSRI's used for OCD?
As they boost serotonin levels
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What are the effects of Tricyclics?
Affect both serotonin and noradrenaline
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When would tricyclics be used over SSRI's?
When people don't respond to SSRI's
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What is the disadvantages of Tricyclics over SSRI's?
- There are more side effects such as hallucinations and irregular heartbeat
- SSRI's have less severe side effects: Nausea, headache and Insomnia
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How do SSRI's work?
- The pre-synaptic neutron releases serotonin to the post-synaptic neuron
- SSRI's inhibit the re-absorbtion of seratonin into the pre-synaptic neutron. It stays in the synaptic gap for longer, boosting serotonin levels in turn reducing OCD
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How do tricyclics work?
The block the reabsorption of serotonin and noradrenaline. As a result more of the neurotransmitters are left in the synapse, and thereby extending their activity, and easing transmission between sending and receiving neuron.
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What are the full names for BZ's?
Benzodiazepines
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What are Benzodiazepines commonly used for?
To reduce anxiety
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How do benzodiazepines work?
- BZ's increase the levels of GABA (a neurotransmitter that has a calming effect on the brain)
- The effect of GABA is to slow down neural firing
- GABA locks onto GABA receptors on the post-synaptic neuron
- This causes an increase in chloride ions into the neuron as the GABA receptors open up to chloride
- Chloride ions make it harder for the neural to be stimulated to fire
- Effect= inhibitory, less firing = brain activity slows down= person feeling calmer
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A03: Drug therapy: Using drugs to treat OCD is supported by research that shows that they are effective
- Soomro reviewed 17 students who used SSRI's with OCD patients and found them to be more effective than placebo's in reducing the symptoms of OCD up to up to three months after treatment i.e in the short term
- But studies only lasted 3 months:most studies are only 1-4 months duration
- this means we know little about the long term effectiveness of drugs
- in addition the effectiveness is greatest when SSRI's are combined with CBT, suggesting a combination therapy is best
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A03: Drug therapy: One strength of drug therapy is that it requires little effort from the patient and little input in terms of time
- psychological therapies are time consuming and costly e.g CBT requires between 15 and 20 sessions plus homework, and for it to be effective, the patient needs to be motivated to discuss their problem and work with it
- drug therapy may therefore suit some people more than others as it fits in better with their personality or lifestyle
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A03: Drug therapy: A further problem of drug therapy is that all drugs have unpleasant side effects
* SSRI's- Nausea, headache and Insomnia
* Tricyclic antidepressants- Hallucinations and irregular heartbeat
* BZ's- Increased aggressiveness and long term impairment of memory, problems with addiction, therefore recommended that BZ's should be used for a minimum of 4 weeks
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A03: Drug therapy: The effectiveness of drugs may be exaggerated by a publication bias towards studies showing drugs have a positive effect
- Turner claimed that there is a publication bias towards studies that show a positive outcome of antidepressant treatment, thus exaggerating the benefits of antidepressant drugs
- The authors found that not only were positive results more likely to be published, but studies that were not positive were often published in a way that conveyed a positive outcome
- Such selective publication can lead doctors to make inappropriate decisions that may not be in the best interests of their patients
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A03: Flooding: Flooding is shown to be effective
- Flooding is at least as effective as other treatment for specific phobias
- Studies comparing therapies have found that flooding is highly effective and quicker than alternatives
- This is a strength because it means that patients are free of their symptoms as soon as possible and that makes the treatment cheaper
- Choy et al also reported that flooding was the most effective at treating phobias
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A03: Flooding: Flooding is less effective for complex phobias such as social phobias
- This may be because social phobias have cognitive aspects
- e.g a sufferer does not simply experience an anxiety response, but thinks unpleasant thoughts about the social situation. This type of phobia may therefore benefit from more cognitive therapies because such therapies tackle irrational thinking
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A03: Flooding: Individual differences-flooding is not for every patient
- It can be a highly traumatic procedure. Patients are obviously made aware of this before-hand but even then they may quit during the treatment which reduces the ultimate effectiveness of the therapy for some people. the time and money are therefore sometimes wasted preparing patients only to have them refuse the treatment. In addition if they start the treatment then stop, they will only have reinforced their fear further
- not only is it sometimes ineffective but also a waste of money.
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A03: Flooding: Symptom substitution may occur
- Behavioural therapies may not work with certain phobias because the symptoms are only the tip of the iceberg
- If the symptoms are remove the cause still remains and the symptoms will only resurface, possibly in another form, this is symptom substitution
- E.g according to the psychodynamic approach phobias develop because of projection
- Freud recorded the case of little Hans who developed a phobia of horses. The boys problem was an intense envy of his father but he could not express this directly and the anxiety was projected onto the horse. The phobia was cured when he accepted his feelings about his father. If the therapist had treated his horse phobia with flooding the underlying problem might have remained and resurfaced elsewhere
- Suggests that flooding cannot be relied upon solely to be a treatment of all phobias
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A03: the cognitive approach to explaining depression: The cognitive explanation is well supported by evidence
(however the fact that there is a link between negative thoughts and depression does not mean that negative thoughts can cause depression) & (Levinson)
- However the fact that there is a link between negative thoughts and depression does not mean that negative thoughts can cause depression. It may mean that for example a depressed individual develops a negative way of thinking because of their depression.
- It could also be that faulty thinking is a vulnerability for abnormality. People with maladaptive cognitive processes are at a greater risk of developing mental disorders because of for example genetic predisposition
- Levinson studied teenagers without depression, he measured their thinking style to determine if it was irrational or rational. A year later he measured the teenagers again and found that the teenagers who had irrational thinking were the teenagers who subsequently developed depression
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A03: the cognitive approach to explaining depression: The cognitive explanation is well supported by evidence (Hammed & Krantz, Bates et al)
- Hammed and Krantz found that depressed participants made more errors in logic when asked to interpret written materials than non-depressed participants.
- Bates et al found that depressed participants who were given negative automatic-thought statements became more and more depressed . Suggesting the view that negative thinking leads to depression
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A03: the cognitive approach to explaining depression: It has led to more successful treatment
- It has been able to be usefully applied. CBT is consistently found to be the best treatment for depression, especially when used in conjunction with drug treatments
- the particular reason as to why these treatments have been so useful is that they have specific implications for the success of therapy and therapy supports the explanation-if depression is alleviated by challenging irrational thinking then this suggests that thoughts had a role in depression in the first place
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A03: the cognitive approach to explaining depression: Irrational thoughts may be realistic
- Not all irrational beliefs are 'irrational', they may simply seem irrational. In fact Alloy and Abrahmson suggested that depressive realists tend to see things with what they are (with normal people tending to view the wold through 'rose tinted glasses'
- They found that depressed people gave more accurate estimated of the likelihood of a disaster than 'normal' controls and called this the 'sadder but wiser' effect.
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A03: the cognitive approach to explaining depression: There are alternative explanations for depression which the cognitive explanation does not take into account
- the biological approach to understanding mental disorders suggests that genes and neurotransmitters may cause depression, for example research supports that there are low levels of Serotonin in depressed people and also found that a gene related to this is 10 times more common in people with depression
- the success of drug therapies for treating depression suggests that neurotransmitters do play an important role. At the very least a diathesis-stress model might be advisable, suggesting that individuals with a genetic vulnerability for depression are more prone to the effect of living in a negative environment, which leads to negative irrational thinking.
