Psychopathology Flashcards
What is statistical infrequency?
Any behaviour that is numerically infrequent/rare so found in very few people
What is an example of statistical infrequency?
Intellectual disability disorder requires an IQ in the bottom 2% of the population
What are the strengths of statistical infrequency?
Is more definitive on the requirements of what is abnormal
What are the weaknesses of statistical infrequency?
Some undesirable traits may be common, and does not account for rare behaviours that may be desirable (e.g. high IQ)
What is deviation from social norms?
Not doing what the majority of society do- (written and unwritten rules of society). Different from how most people behave, in a way that is socially unacceptable
What is an example of deviation from social norms?
For example: breaking written social rules: being indecent in public, breaking unwritten social rules: sitting next to the only person on an empty bus
What are the strengths and weaknesses of deviation from social norms?
Defines what is and is not acceptable. HOWEVER- it is not fixed/open to change (social norms change)- not an objective, reliable measurement. And is affected by culture.
What is an example of the weakness of deviation from social norms?
Change over time: e.g. Drapetomania- used to be a medical condition; slaves showed an ‘irrational’ desire to escape, can be abused by creation of mental illnesses
What is failure to function adequately? And an example
Not being able to properly go about daily life/cope with everyday life e.g. not being able to hold down a job
What are the strengths of failure to function adequately?
Can be assessed using a questionnaire called WHODAS, high score = poor functioning, recognises the subjective experience of the patient, also relatively easy to judge objectively
What are the weaknesses of failure to function adequately?
Related to cultural ideas about how people should live, some dysfunctional behaviours may be quite functional, it depends on who is making the judgement (e.g. some Szs feel that their dangerous behaviour is perfectly normal)
What is deviation from ideal mental health? and example
Not having ideal mental wellbeing, not meeting criteria for ideal mental health e.g. a schizophrenic person may not have an accurate view of reality
What are the criteria for ideal mental health?
- positive view of self, 2 self actualisation, 3 resistance to stress, 4 accurate view of reality, 5 independence, 6 mastery of the environment
What are the strengths of deviation from ideal mental health?
definitive criteria for what is and is not ideal mental health (so what is abnormal/undesirable)
What are the weaknesses of deviation from ideal mental health?
Culturally doesn’t work, based on western ideals, can anyone actually achieve ‘ideal’ mental health, some criteria are too vague
What are the behavioural and emotional characteristics of phobias?
B: avoidance, freezing
E: persistent excessive fear, anxiety
What are the cognitive characteristics of phobias?
Irrational beliefs, cognitive distortions, adults typically know their fear is excessive whereas children do not
What is a phobia?
An anxiety disorder that interferes with daily living
What is the two process model of phobia creation and maintenance?
phobias are initiated through classical conditioning (learning through association) and maintained through operant conditioning (negative reinforcement)
What are the strengths of the behavioural explanation of phobias?
Research support (Watson and Rayner/little albert) Has lead to successful treatment (counter conditioning/systematic desensitisation and flooding)
What are the weaknesses of the behavioural explanation of phobias?
Evidence that challenges the behavioural explanation (DiNardo, Menzies and Clarke) , Alternative explanations (Seligman’s biological preparedness), Ignores cognitive factors
What did DiNardo find?
That not all people who are bitten by dogs developed a phobia of dogs
What did Menzies and Clarke find?
That only 2% of water phobic children could remember a direct conditioning experience with water
What was Seligman’s biological preparedness theory?
That we are genetically prepared to rapidly learn an association between potentially life threatening situations/stimuli and fear
What cognitive factors could be involved in phobias?
irrational thinking- such thoughts can trigger extreme anxiety and cause a phobia- can explain different responses to the same event (which behaviourism can’t)
What is systematic desensitisation?
Graded exposure to fears- patient creates a hierarchy of fears which the treatment progresses through from the smallest fears to the largest fear- patient is taught relaxation techniques and is exposed at each stage until relaxed
What are the strengths of systematic desensitisation?
Research support (Gilroy), can be used for a diverse range of patients, less traumatic than flooding
What was Gilroy’s research?
Followed up 42 pps treated for spider phobia with 3 sessions of systematic desensitisation, control group was treated with relaxation without exposure.
At 3 months and 33 months, SD group were less fearful than control group.
Why is Systematic desensitisation better for a wider range of patients?
People/children with learning difficulties or who are too young to understand may be confused and more fearful if exposed to flooding or be able to engage with cognitive therapies that require ability to reflect on thinking.
What are the weaknesses of systematic desensitisation?
Not appropriate for all phobias (e.g. those that have underlying evolutionary survival component) and symptom substitution may occur (Freud), time commitment to multiple sessions
What was Freud’s study?
Little Hans- phobia of horses, but underlying problem was an intense envy of his father but projected this onto the horse. Phobia only cured when he accepted his feelings towards his father.
What is flooding?
Immediate exposure to the stimulus/intense form of the stimulus. Prevention of avoidance, exposure doesn’t stop until they are calm (anxiety will peak and eventually subside)
What are the strengths of flooding?
Shown to be effective (Ougrin), requires less time commitment than SD
What are the weaknesses of flooding?
Not as effective for complex phobias (e.g. social phobias)- could actually make their phobia worse, individual differences patients may not want to see it through - which wastes time and money and if they have started the flooding- could make fear worse, symptom substitution
What did Ougrin find?
That flooding is highly effective and quicker than alternatives- means that its is more cost effective - more available to patients with little time or money for other treatments
What is the cognitive explanation of depression?
Depression is caused by irrational or distorted thinking/view of reality
What are the two cognitive explanations of depression?
Ellis’ ABC model and Beck’s negative triad
What is Beck’s theory of negative schemas and cognitive biases?
Faulty info processing= selective attention to the negative aspects of situations. Acquire negative schemas in childhood, affects how info is interpreted (cognitive bias).
What are the thinking styles typical in depression?
All or nothing- must succeed at everything or have failed, Labelling of self- I’m so stupid, overgeneralisation- one negative event seen as a ‘constant’ occurrence
What is Beck’s negative triad?
View of self, view of world, view of future (clockwise)
What are the strengths of Beck’s theory?
Research support (Gustafson), Development of successful therapies (challenging faulty thought patterns)
What was Gustafson’s research?
Found irrational thinking processes displayed by many people with psychological disorders such as anxiety and depression
What are the weaknesses of Beck’s theory?
Cause and effect (did the thought process come first or the depression?), blames abnormality on the patient (often overlooks situational factors- that the individual cannot control)
What is Ellis’ ABC model?
A= Activating an event (e.g. getting fired) B= beliefs about the event that can be rational or irrational (e.g. company is bankrupt OR I'm worthless) C= consequences of those beliefs- Rational= healthy emotions/behaviours, irrational=unhealthy emotions/behaviours
What does the ABC suggest is the source of irrational beliefs?
A rigid belief that certain things ‘must’ be true in order for us to be happy. These ‘musts’ need to be challenged in order for mental happiness to prevail
What are the strengths of the ABC model?
Research support (Lewinsohn),
What are the weaknesses of the ABC model?
Suggests that mental disorders stem from a specific event- not always the case, ignores other explanations
What are the strengths of the cognitive explanation?
Successful treatment (CBT/Cuijipers), research support (Hammen and Krantz)
What was Lewinsohn’s study?
Tested thinking pattern in teens who were not depressed, then again a year later. Those with negative, unrealistic thoughts a year earlier more likely to develop depression. Suggests CAUSE + EFFECT
What did Cuijipers find?
That CBT was the most effective form of therapy-especially when used in conjunction with drug trials
What are the weaknesses of the cognitive explanation?
Blames client, irrational beliefs may be realistic (Alloy and Abrahamson), alternative explanations (Zhang)
What did Alloy + Abrahamson find?
That depressive realists may simply see things more realistically than others who view situations in the best possible light. Depressed pps gave more accurate estimates of likelihood of disaster than ‘normal’ controls
What did Zhang et al find?
That gene related to low serotonin levels is 10 times more likely in those with depression
What did Hammen and Krentz find?
That pps made more error in logic when asked to interpret written material, than non-depressed pps
What is CBT?
combines cognitive and behaviourist approaches, cognitive focuses on challenging irrational thinking and the behaviourist is done in the form of homework between therapy sessions to back up new thinking
What are the principal sections of CBT?
identify irrational thinking, challenge it through questioning, replacing irrational thoughts with more rational ones.
Behavioural tasks to back up changed beliefs, learn new techniques e.g. thought stopping/self-talk
How is irrational thinking challenged?
Empirical disputing: asking for evidence
logical disputing: does it make sense
Pragmatic disputing: is this thinking helpful to you
What are two types of CBT?
Beck’s cognitive therapy, Ellis’ REBT
What is Beck’ cognitive therapy?
Negative schemas/cognitive biases challenged, negative automatic thoughts in cognitive triad challnged
What is Ellis’ REBT?
Challenges negative beliefs seen in ABC model, disputing these/changing them into more rational ones
What are the strengths of CBT?
Research support (Ellis, Fava), shown to be effective in changing behaviour through homework tasks(Babayak)
What are the weaknesses of CBT?
Individual differences influence effectiveness (Simons), requires commitment (Ellis), various other therapies (Luborsky)
What did Babayak find?
Randomly assigned 156 majorly depressed adults 4 months of exercise, drugs or both- all improved but 6 months later those in exercise groups had significantly lower relapse rates
What did Ellis find?
90% success rate with CBT completed over an average of 27 sessions
What did Fava find?
Patients with recurrent depression randomly assigned drug therapy or drug therapy and CBT. 75% of drug + CBT group still symptom free after 2 years versus just 25% of drug only
What did Simons find?
CBT less suitable in situations where high levels of stress in the individual reflect realistic stressors that therapy can’t resolve
What did Luborsky find?
Reviewed over 100 different studies that compared therapies and found only small differences
What are the 4 definitions of abnormality?
statistical infrequency, deviation from social norms, failure to function adequately, deviation from ideal mental health
What are the behavioural characteristics of depression?
lack of motivation to do daily tasks, (e.g. hygiene, eating), oversleeping,
What are the cognitive characteristics of depression?
irrational and overly negative thought process (e.g. I don’t deserve to be alive, no one cares about me, everyone would be better off without me)
What are the emotional characteristics of depression?
Loss of emotion, feeling ‘empty’, low emotions/moods, sadness,
What are the behavioural characteristics of OCD?
COMPULSIVE behaviours: repetitive (e.g. hand washing) give temporary relief from anxiety, avoidance (e.g. of germs or contamination)
What are the emotional characteristics of OCD?
High levels of anxiety and distress, shame (sufferers know that their behaviour is excessive)
What are the cognitive characteristics of OCD?
OBSESSIVE thoughts: recurrent (keep having the same thoughts), intrusive (can’t be ignored), uncontrollable (have to be acted upon)
What are the genetic explanations for OCD?
Their genetic makeup: COMT gene or SERT gene
What are the neural explanations for OCD?
Their brain functioning: Abnormal neurotransmitter levels or abnormal brain circuits
How do psychologists investigate genetic influences on behaviour?
Family studies, twin studies, adoption studies
What does the genetic explanation suggest?
That a predisposition/vulnerability to OCD may be inherited. However OCD appears to be a polygenic condition where a number of genes are involved
What does the SERT gene do?
Affects the transport of serotonin
How could a mutated SERT gene cause OCD?
Mutation could = increase in serotonin re-uptake, thus lower levels of serotonin in the synaptic gap.
What does the COMT gene do?
Regulates dopamine production
How could a mutated COMT gene cause OCD?
Lower activity of the COMT gene, thus higher levels of dopamine
What support is there for the genetic explanation of OCD?
Family studies: Ozaki et al, Nestadt et al,
Twin studies: Billet
What did Ozaki et al find?
Mutation of SERT gene was found in two unrelated families where 6 of the 7 family members had OCD
What did Nestadlt et al find?
(G1: 80 pps with OCD and 343 of their 1st degree relatives. G2: control group without mental illness and their relatives)
People with 1st degree relatives with OCD had a 5x greater risk of OCD
What did Billet et al find?
meta analysis of 14 twin studies
Found MZ twins more than 2x as likely to develop OCD if their co twin had it than DZ twins
What are the weaknesses of the genetic explanation for OCD?
Genetic explanations cannot provide a full explanation (concordance is never 100%)
There are no genes specific to OCD- certain gene mutations merely increase likelihood of obsessive type behaviours (also seen in Anorexia, Tourette’s and Autism)
How can abnormal levels of neurotransmitters cause OCD? Serotonin
Imbalance of serotonin: serotonin is involved in regualting mood. OCD could = low levels of serotonin.
As low levels of serotonin associated with high anxiety
Its also thought it is involved in helping caudate nucleus and OFC- so low levels may cause them to malfunction
How can abnormal levels of neurotransmitters cause OCD? Dopamine
Dopamine imbalance: high dopamine levels in OCD. Dopamine involved in attention/concentration. High dopamine levels may = being unable to stop focusing on obsessive thoughts and behaviours
What is the support for abnormal levels of neurotransmitters in OCD?
Szechtman et al, Pigott et al
What did Szechtman et al find?
High doses of drugs that enhance dopamine induce movements resembling compulsie behaviours found in OCD patients
What did Pigott et al find?
Antidepressant drugs that increase serotonin levels can reduce OCD syptoms
What does the Orbitofrontal cortex circuit include?
Orbitofrontal cortex (OFC), caudate nucleus and the thalamus.
What is the OFC involved in?
decision making and the regulating of emotion: when activated you become aware of your primal instincts and brain makes a decision as to how to respond to this impulse
What does the caudate nucleus do?
acts as a filter, screening out irrelevant or unimportant impulses, most powerful ones are passed onto the thalamus
What does the thalamus do?
Plays a role in controlling motor systems of the brain- so drives individual to think more about impulse and take action
How does the orbitofrontal cortex circuit change for someone with OCD?
minor worry signals from OFC aren’t suppressed by the caudate nucleus and thalamus is alerted- which sends signals back to the OFC if worry signals are not addressed creating a ‘worry circuit’
What support is there for the OFC circuit explanation?
Menzies- MRI scanned OCD pps brain activity + close family members without OCD and unrelated ‘healthy’ group.
OCD and close relatives had reduced grey matter in the OFC; supports anatomical difference inheritance which could cause OCD
(BUT that the family members did not have OCD suggests environmental factors)
What is the overall criticism of the biological explanation?
Alternative explanations e.g. two process model
Success of behavioural treatments
How can the two process model be applied to OCD?
initial learning occurs when NS associated with anxiety
negatively reinforced by avoidance, obsession is now formed and compulsive behaviours learnt as these appear to reduce anxiety, thus OCD can be explained environmentally
How have behavioural therapies been effective in OCD treatment?
exposure and response therapy- 60-90% of OCD patients improved considerably. Suggests OCD linked to maladaptive learning
What are the different drug types used to treat OCD?
SSRIs, tricylics, anti-anxiety drugs
What does SSRIs stand for?
Selective Serotonin Reuptake Inhibitors
How do SSRIs increase serotonin levels in OCD patients?
Inhibit the characteristic fast reuptake of serotonin in OCD- allows serotonin to build up in the synaptic gap (to normal levels) reducing low-serotonin associated behaviours e.g. obsessive thoughts + consequent compulsive behaviours
How do tricyclics work?
They block the reabsorption of serotonin and noradrenaline. So more of these are left in the synaptic gap and thereby extending their activity and easing transmission between sending and recieving neuron
How do anti-anxiety drugs work?
Benzodiazepines (BZs) work by increasing the neurotransmitter GABA (anxiety relief neurotransmitter).
What does an increase of GABA do?
The effect of GABA is to slow the firing of the brain. GABA locks onto GABA2 receptors on recieving neuron.
This = increase in chloride ions into neuron- which make it harder for that neuron to fire.
What are the strengths of drug therapy to treat OCD?
Research support (Soomro), requires little effort from the patient and little time input
What are the weaknesses drug therapy to treat OCD?
Not a lasting cure (Maina), unpleasant side effects, effectiveness of drugs may be exaggerated by publication bias towards studies showing a positive effect (Turner)
What did Soomro find?
reviewed 17 studies of SSRI use to treat OCD- found them to be more effective than placebos in reducing symptoms up to 3 months post treatment
(but little long term evidence)
What did Maina find?
patients relapse within a few weeks if medication is stopped
What are the side effects of drug therapy for OCD?
SSRIs- nausea, headache, weight gain, insomnia
Trycyclics- hallucinations, irregular heartbeat
BZ’s- aggressiveness, long term memory impairment, max. 4 week use due to addiction issues
What did Turner find?
evidence of publication bias towards studies showing positive effect of drug therapies, thus exaggerating their benefits. Also found that studies that weren’t positive often conveyed in a way suggesting positive outcome- much research is funded by the drug companies (!)
