PSYCHOPATHOLOGY Flashcards
strength of statistical infrequency as a definition of abnormality
real-life application:
all assessments of patients with mental disorders involve some comparison to statistical norms. intellectual disability disorder demonstrates how statistical infrequency can be used. thus a useful part of clinical assessment
limitation of statistal infrequency as a definition of abnormality
unusual characteristics can also be positive:
if very few people display a behaviour, that makes the behaviour statistically abnoral but doesn’t necessarily mean the person requires treatment. IQ scorers of over 130 are just as abnormal as those who score below 70 but aren’t regarded as undesirable and requiring treatmet. limitaion of concept of statistical infrequency and means it should never be used alone to make a diagnosis
limitations of deviation from social norms as a definition of abnormality
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social norms are culturally relative:
a person from one cultural group may label another person from another cultural group as abnormal using thei standards rather than that persons standards. e.g hearing voices is socially acceptable in some cultures but would be seen as a sign of abnormality and even schizophrenia in the UK. creates problems for people from one culture living within another cultural group
not a sole explanation of abnormality:
APD shows there is a place for deviation from social norms in thinking about what is abnormal. however, there are other factors to consider e.g distress to other people from APD. so in practice, deviation from social norms is never the sole reason for defining abnormality
BUT better explanation of antisocial personality disorder than failure to function as psychopaths are high functioning. definition had to be changed for failrue to function from experiencing personal distress to distressing others
limitations of failure to function adequately as a definition of abnormality
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same as deviation from social norms:
can be hard to say when someone is really failing to function or just deviating from social norms. people who live extreme lifestyles or do extreme sports could be seen as behaving maladaptively (bahving in a way that is dangerous). if we treat these behaviours as failures of adequate functioning we may limit freedom
subjective judgement:
someone has to judge whether a patient is distressed or distressing. some patients my say they are distressed but may not be judged as suffering. there are methods for making these judgements as objective as possible e.g checklists such as the Global Assessment of Functioning Scale. however the principle remains whether someone e.g a psychiatrist, has the right to make this judgement
limitations of deviation from ideal mental health as a definition of abnormality
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definition may be culturally relative:
some of the criteria in Jahoda’s classification of ideal mental health are specific to Western cultures. e.g emphasis on self-actualisation would be considered self-indulgent in much of the worldwhere the focus is on community and not on oneself. such traits are typical of individualist cutures and are culturally specific
unrealistically high standards for mental health:
very few people will attain all Jaohd’a crieria for mental health. so this approach would see most of us as abnormal. one the positive side, it makes it clear to people the ways in which they could benefit from seeking help to improve their mental health. however, this criteria could worry many people as they believe to not be in an ideal mental state
strength of the behavioural approach to explaining phobias
two-process model has good explanatory power:
went beyond Watson & Rayner’s simple classical conditioning explanation of phobias. important implications for therapy as patients are instead exposed to their phobic object to prevent them practicing avoidance behaviour. The success of these therapies shows phobais are maintained through negative reinforcement.
limitations of the behavioural approach to explaining phobias
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alternative explanations for avoidance behaviour:
in more complex behaviours like agoraphobia, there is evidence that at least some avoidance behaviour is motivated more by positive feelings of safety (Buck). explains why some agoraphobics are able to leave the house with a trusted friend with relatively little anxiety but not alone. problem for two-process model which suggests avoidance is purely motivated by anxiety reduction
not all bad experiences lead to phobias:
DiNardo et al. found over 60% of people in their sample with a dog phobia related their phobia to a frightening experience. however in a control group without a dog phobia, a similar proportion also reported such an experience. only limited evidence for classical conditioning explanation
doesn’t properly consider the cognitive aspects of phobias:
behavioural explanations are generally orientated towards explaining behaviour rather than cognition. two-process model explains maintenance of phobias in terms of avoidance but we also know that phobias have a cognitive element which could help maintain them such as irrational beliefs and selective attention. two-process theory doesn’t adequately address the cognitive element of phobias
strengths of systematic desensitation as a treatment for phobias
effective:
Gilroy et al. followed up 42 patients who had SD for spider phobia in 3 45 minute sessions. at both 3 and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure. strength because it shows that SD is helpful in reducing the anxiety in spider phobia and that the effects of the treatment are long-lasting
suitable for a diverse range of patients;
alternatives to SD such as flooding and cognitive therapies are not well suited to some patients. e.g having learning difficulties can make it very hard for some patients to understanding what is happening during flooding or to engage with cognitive therapies which require reflection. SD most appropriate treatment
limitations of flooding as a treatment of phobias
less effective for some types of phobia:
highly effective for treating simple phobias but less so for more complex phobias like social phobias. may be because social phobias have cognitive aspects e.g a sufferer of social phobia doesn’t simply experience anxiety but thinks unpleasant thoughts about the social situation. this type of phobia may benefit more from cognitive therapies because such therapies tackle the irrational thinking
flooding is traumatic for patients:
most serious issue is that it is a highly traumatic experience. problem isn’t that flooding is unethical (patients give informed consent) but that patients are often unwilling to see it through to the end. ultimately means the treatment is uneffective and time and money are wasted preparing patients only to have them refuse to start or complete treatment
strengths of explanations of depression
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good supporting evidence:
Grazioli & Terry assessed 65 pregnant women for cognitive vulnerability and depression before and afetr birth. they found that those women judged to have been high in cognitive vulnerbaility were more likely to suffer post-natal depression. these cognitions can be seen before depression develops, suggesting that Beck may be right about cognition causing depression, at least in some cases (prospective study)
theory has a practical application as a therapy:
Beck’s cognitive explanation forms the basis of cognitive behaviour therapy. the components of the negative triad can be easily identified and challenged in CBT which has shown to be effective (Cuijpers et al. found high/moderate effectiveness) the success of CBT which is based on Beck’s explanation of depression supports it (clinical trials)
Koster et al. found depressed participants took longer to press a button whe the word was negative than a control group. this suggests that people with depression focus on the negatives which provides support for the cognitive theory (lab study)
WELL TRIANGULATED EVIDENCE
strength of CBT as a treatment of depression
effective:
large body of evidence to support effectiveness e.g March et al. compared effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents. after 36 weeks 81% of the CBT group, 81% of the antidepressant group and 86% of the combined group were significantly improved. CBT emerged as just as effective as medication and even more helpful alongside medication. good case for making CBT the first choice of treatment in the NHS
limitations of CBT as a treatment for depression
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may not work for the most severe cases:
in some cases depression can be so severe that they can’t motivate themselves to do the hard cognitive work required for CBT. where this is the case it is possible to treat patients with antidepressants and commence CBT when they are more motivated. cannot be used as sole treatment for all cases of depression
some patients really want to explore their past:
one of the principles of CBT is that the focus of the therapy is on the patient’s present and future, not on their past. other forms of psychotherapy allow patients to make links between childhood experiences and current depression. ‘present-focus’ of CBT may ignore an important aspect of the depressed patient’s experience
may be an overemphasis on cognition:
CBT may minimise the importance of the circumstances in which the patient is living. a patient living in poverty or suffering abuse needs to change their circumstances and any approach that emphasises what is in their mind rather than their environment can prevent this. CBT techniques used inappropriately can demotivate people to change their situation
strength of genetic explanations of OCD
supporting evidence:
evidence from a variety of sources which suggests some people are vulnerable to OCD as a result of their genetic make-up. Nestadt et al. reviewed twin studies and found and found that 68% of identical (MZ) twins shared OCD as opposed to 31% of non-identical (DZ) twins. strongly supports genetic influence on OCD
limitation of genetic explanations of OCD
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environmental risk factors are involved:
not just genes but also environmental risk factors can trigger or increase risk of developing OCD. Cromer et al. found that over half of the OCD patients in their sample had a traumatic event in their past, and OCD was more severe in those with one or more traumas. supports the diathesis stress model. may be more productive to focus on environmental causes as more able to do something about them
and little predictive value compared to environmental explanations as aetiologically heterogenous and polygenic
strength of neural explanations of OCD
supporting evidence:
antidepressants that work purely on the serotonin system are effective in reducing OCD symptoms which suggests that the serotonin system may be involved in OCD. e.g as shown by Soomro who over found 17 studies SSRIs more effective than placebos. successful drug therapy supports implication of serotonin
