Psychopathology - Paper 1 Flashcards
1
Q
What are the 4 definitions of abnormality?
A
. Statistical infrequency
. Deviation from social norms
. Failure to function adequately
. Deviation from ideal mental health
2
Q
What is statistical infrequency?
A
Where an individual has a less common characteristic (when compared to the rest of a population) eg. being more or less depressed/intelligent than the rest of the population.
3
Q
What are some examples of statistical infrequency?
A
We know that in any human trait, the majority of peoples score will cluster around the average, and that the further we go above or below that average, the fewer people will attain that score. This is called the normal distribution The statistical approach is especially useful in assessing characteristics that can be reliably measured eg:
. Intelligence - the average IQ is 100. In a normal distribution, 68% of people have a score from 85-115. Only 2% have a score below 70 - these individuals are considered abnormal and may receive a diagnosis such as intellectual disability disorder.
4
Q
What is a strength of statistical infrequency - real world application?
A
A strength of the theory is its usefulness. It can be used in clinical practice, both as part of a formal diagnosis and as a way of assessing severity of symptoms eg. a diagnosis of Intellectual disability disorder requires an IQ below 70. An example of statistical infrequency being used in clinical practice is the Beck Depression Inventory, with a score of 30+ (5% of participants) indicating severe depression. This shows the value of statistical infrequency as if can be used for diagnostic and assessment purposes
5
Q
What is a limitation of statistical infrequency - unusual characteristics may be positive?
A
For every person with an IQ below 70, there is another with an IQ above 130, yet people with unusually high IQ’s are not considered abnormal. Similarly, someone with an unusually low score on the Beck’s Depression Inventory is not seen as abnormal. This shows that being unusual or at one end of a psychological spectrum doesn’t necessarily make someone abnormal. Although statistical frequency has value, especially in diagnosis and assessment settings, it can’t be used as the sole basis for defining abnormality.
6
Q
What is Deviation from social norms?
A
Where behaviour violates the accepted standards of behaviour in a social group - when it differs from the accepted norm.
7
Q
What factors need to be considered when assessing Deviation from social norms?
A
What is seen as acceptable behaviour varies from culture to culture and generation to generation eg. homosexuality was seen as abnormal in Britain in the past, and in some cultures today.
As a result, it is necessary to consider:
. The degree to which a norm is violated
. The importance of the norm/the value attached to it by a social group eg. is the violation rude, abnormal, criminal?
8
Q
What are some examples of Deviations from social norms?
A
. Homosexuality
. Antisocial personality disorder - psychopaths are impulsive, aggressive and irresponsible which often means their behaviors are in conflict with what society deems acceptable. Also, the DSM-5 states that a ‘failure to conform to lawful and culturally normative ethical behaviour’ is a symptom of psychopathy - psychopaths are considered abnormal as they don’t conform to our moral standards.
9
Q
What is a strength of Deviation from social norms - real world application?
A
Deviation from social norms is used in clinical practice eg.in defining psychopathy where a failure to conform to culturally acceptable behaviour is seen as a symptom, or in the diagnosis of schizotypal personality disorder where the thinking, behavior and appearance of people with the disorder is described as ‘strange’. As such, the criteria involved in deviation from social norms has value in psychiatry and real world applications.
10
Q
What is a limitation of Deviation from social norms - cultural and situational relativism?
A
. CULTURAL AND SITUATIONAL RELATIVISM - Different cultures and situations have different social norms. As a result, someone assessing abnormality in a foreign culture may define people based on their own cultures standards of abnormality, rather than the persons. Examples of cultural differences can be found in the diagnosis of schizophrenia (hearing voices can be seen as positive in one culture eg. a message from ancestors, but negative in another) and in tribes such as the Kayan tribe in Myanmar ( who wear brass collars to lengthen their necks as this is seen as attractive) . Also, even within a cultural context social norms differ from situation to situation - deceitful behaviour is more unacceptable in a family context than in a corporate one. This means that it is difficult to use deviation from social norms as a marker for abnormality between cultures and situations.
11
Q
What is a limitation of Deviation from social norms - potential of human rights abuses?
A
Labelling someone as abnormal because they deviate from social norms exposes them to unfair labelling and abuse eg. diagnoses’ such as drapetomania (black slaves running away ) which was used to control slaves and avoid debates about the morality of slavery raised by them running away, or nymphomania, used to regulate women’s sexual behaviour.
12
Q
What is failure to function adequately?
A
Where someone is unable to behave in a way necessary to cope with the demands of ordinary, day to day living
13
Q
How can you tell if someone is failing to function adequately?
A
. Being unable to meet basic standards of hygiene and nutrition
. Being unable to hold down a job or maintain relationships
. Rosenhan and Seligman (1989) proposed 7 criteria typical of FFA:
- Unpredictability/loss of control
- Maladaptive behaviour
- Irrationality
- Violation of moral standards
- Personal distress
- Observer discomfort
- Unconventionality
14
Q
What is an example of Failure to function adequately?
A
. Intellectual disability disorder - a diagnosis for this is made based on both statistics (IQ below 70) and if an individual shows signs of being unable to cope with the everyday demands of life
15
Q
What is a strength of Failure to function adequately - clear threshold for help?
A
FFA criteria is a sensible threshold that can be used when people need professional help. Most people have symptoms of mental health disorder at some point - 25% of people experience mental health problems in a given year - however many people are able to function in day to day life. It tends to be the point where people are unable to function adequately that professional help is sought. Using this criteria means professional help can be provided for those most needing of it.
16
Q
What is a limitation of Failure to function adequately - discrimination?
A
It is easy to label non-standard life choices as abnormal, however it can be difficult to say in practice where someone is genuinely failing to function or where they have chosen to deviate from social norms. Eg. not having a job could be seen as failure to function, or someone could just have chosen to live off the grid. Similarly, people who favor high risk lifestyles could be unreasonably defined is abnormal and irrational. This means people who make these choices are at risk of being labelled as abnormal and having their freedoms and rights restricted, raising serious ethical concerns and negative social implications.
17
Q
What is a limitation of Failure to function adequately - failure to function may not indicate abnormality?
A
Someone may just be in a period eg. bereavement where they fail to cope for a time. It is unfair to give someone a label that may cause them future problems based on their reaction to difficult circumstances at one time. However it could be argued that if their reaction makes them unable to cope with everyday life, they may still need professional help so they can adjust to these new circumstances.
18
Q
What is Deviation from ideal mental health?
A
Where someone fails to meet the criteria of being psychologically/mentally healthy
19
Q
What is the 6 point criteria for ideal mental health?
A
Jahoda (1958) suggested that someone had good mental health if they met the following criteria:
. Positive attitude toward the self - good self esteem, lack guilt
. Self actualisation - striving to reach their potential
. Autonomy
. Resistance to stress
. Environmental mastery - can adapt well to new situations
. Accurate perception of reality
20
Q
What is a strength of Ideal mental health - highly comprehensive?
A
Jahoda’s concept of ideal mental health includes a range of criteria for distinguishing mental health from mental disorder, covering most of the reasons someone may be referred for help with mental health. As such, an individuals mental health can be discussed meaningfully with a range of professionals . Ideal mental health provides a checklist against which we can assess ourselves and others, enabling them to discuss psychological issues with professionals.
21
Q
What is a limitation of Ideal mental health - culture bound?
A
The different elements of the mental health criterion are not equally applicable across a range of cultures. Some of Jahoda’s ideas are deeply rooted in the values of the US and Europe - eg. there is emphasis placed on self-actualisation, but this may be considered self-indulgent in different parts of the world, and independence is seen as less significant in collectivist cultures. Furthermore what defines success in working, social and love lives is different in different cultures. This means that the concept of ideal mental health has limited applicability from culture to culture
22
Q
What is a limitation of Ideal mental health - high standards for mental health?
A
The criteria Jahoda proposes could be seen as unreasonable. Very few people attain her criteria fully, and it is highly unlikely that someone could achieve all of them at the same time, for a long period of time. Such high standards could be disheartening for people attempting to improve mental health. As such, the criteria could have a negative effect on recovery and society in general.
23
Q
What is a phobia?
A
An irrational fear of an object or situation
24
Q
What are the different types of phobia?
A
. Specific phobia - Fear of an object or situation
. Social phobia - Fear of a social situation
. Agoraphobia - Fear of being outside/in a public place
25
What are the behavioural characteristics of phobias?
. Avoidance
. Panic
. Endurance
26
What is Avoidance?
People with phobias tend to go to great lengths to avoid coming into contact with a phobic stimulus. This may limit their ability to function normally in everyday life
27
What is Panic?
Someone with a phobia may experience high levels of stress/anxiety when faced with a phobic stimulus. They may cry, scream, run away, freeze etc. Children are more likely to freeze, cling or have a tantrum
28
What is Endurance?
The alternative response to avoidance is endurance, where the person with a phobia chooses to remain in the presence of the phobic stimulus eg. a person with arachnophobia chooses to stay in the room with a spider in order to keep an eye on it
29
What are the emotional characteristics of phobias?
. Anxiety
. Fear
. Unreasonable emotional response
30
What is Anxiety?
Phobias evoke an emotional response of anxiety (an unpleasant state of high arousal). This prevents a person relaxing and makes it difficult to experience any positive emotion. Anxiety may be long term
31
What is Fear?
The immediate and extremely unpleasant response experienced when someone encounters/thinks about a phobic stimulus. It is usually more intense than anxiety, but is experienced in shorter periods
32
What is meant by 'Unreasonable emotional response'?
The anxiety and fear experienced is greater than what is considered 'normal' and is disproportionate to any threat posed.
33
What are the cognitive characteristics of phobias?
. Selective attention
. Irrational beliefs/thinking
. Cognitive distortions
34
What is Selective attention?
When presented with a phobic stimulus, the person is unable to direct their attention elsewhere, becoming fixated on the object they fear.
35
What are Irrational beliefs/thinking?
A person with a phobia may hold unfounded thoughts in relation to phobic stimulus - thoughts that can't be easily explained and aren't based in reality.
36
What are Cognitive distortions?
The perceptions of someone with a phobia may be inaccurate and unrealistic eg. someone with mycophobia sees mushrooms as disgusting
37
What is depression?
A mental disorder characterised by low moods/changes in mood and low energy levels. It is classified as a mood disorder.
38
What are the recognised categories of depression?
. Major depressive disorder - Severe but often short term depression
. Persistent depressive disorder - Long term or recurring depression. Symptoms must be experienced for 2 years in order to receive a diagnosis.
. Disruptive mood dysregulation disorder - Severe ' Childhood temper tantrums' which involve chronic irritability. disproportionate reactions etc.. Found in children aged 6-18
. Premenstrual dysphoric disorder - Disruption to mood prior to/during menstruation.
39
What are the two types of depression?
. Unipolar depression - typical symptoms with no manic episodes
. Bipolar depression - characterised by the typical behavioural, emotional and cognitive symptoms as well as occasional manic symptoms
40
What are the behavioural characteristics of depression?
. Activity levels
. Disruption to sleep and eating behaviour
. Aggression and self harm
41
What does 'Activity levels' refer to?
Typically people with depression have low energy levels, making them lethargic. This has a knock on effect, causing people to withdraw from work, education and social life. In extreme cases this can be so extreme that the person is unable to get out of bed. Alternatively, depression can lead to psychomotor agitation, where individuals struggle to relax, can't sleep, pact etc..
42
What is meant by 'Disruption to sleep and eating behaviour'?
Someone with depression may experience insomnia (reduced sleep) where they wake prematurely, or hypersomnia (increased need for sleep). Similarly, appetite and eating may increase or decrease, resulting in weight gain or loss.
43
What is meant by 'Aggression and Self harm'?
People with depression are often irritable, and in some cases can become verbally or physically aggressive. This can have serious knock on effects in their work and personal lives. They can also be physically aggressive towards themselves, which includes self harm or suicide attempts.
44
What are the emotional characteristics of depression?
. Lowered mood
. Anger
. Lowered self esteem
45
What is meant by 'Lowered mood'?
Lowered mood is a defining element of depression, but is more pronounced than everyday feelings of being lethargic and sad. People with depression often describe themselves as worthless and empty
46
What is Anger (in relation to depression)?
People with depression often experience (sometimes extreme) anger. This can be directed at the self or others, with these emotions sometimes leading to aggressive or self-harming behaviour
47
What is meant by Lowered self-esteem?
Self-esteem is the emotional experience of how we view ourselves. People with depression tend to report low-self esteem (liking themselves less than usual). This can be extreme, with some depressed people describing a sense of self-loathing.
48
What are the cognitive characteristics of depression?
. Poor concentration
. Dwelling on the negative
. Absolutist thinking
49
What is meant by Poor concentration?
Depression is associated with poor levels of concentration, where the person may find themselves unable to stick to a task as they normally would, or struggling to make straightforward decisions. Poor concentration and decision making are likely to interfere with the individuals work
50
What is Dwelling on the negative?
People experiencing depressive episodes are likely to pay attention to the negative aspects of a situation, and ignore the positive. They are also likely to have a bias towards recalling unhappy events, rather than happy ones (the opposite bias to what most people have when not depressed)
51
What is Absolutist thinking?
Most situations are not all good or all bad, but people with depression tend to think in these 'black and white terms' . This means that when a situation is unfortunate they see it as an absolute disaster
52
What is OCD?
A condition characterised by obsessions and/or compulsive behaviour
53
What are obsessions?
Re-occurring and persistent thoughts which are not based in reality
54
What are compulsions?
Repetitive behaviours/physical urges to perform actions in order to reduce feelings of anxiety caused by obsessions
55
What percentage of OCD sufferers experience both obsessions and compulsions?
70%
56
What percentage of OCD sufferers experience obsessions alone?
20%
57
What percentage of OCD sufferers experience compulsions alone?
10%
58
What is the difference between obsessions and compulsions?
Obsessions are a cognitive process - it takes place in the mind, while compulsions refer to the behaviour - it something you do
59
What are the behavioural characteristics of OCD?
. Compulsions are repetitive
. Compulsions are used to reduce anxiety
. Avoidance
60
What is meant by the idea that Compulsions are repetitive?
People with OCD typically feel compelled to repeat a behaviour eg. repetitive hand washing
61
What is meant by the idea that Compulsions are used to reduce anxiety?
While some sufferers experience compulsions alone, the majority of people with OCD use compulsions in order to manage anxiety caused by obsessions. eg. compulsive hand washing is a response to an obsessive fear of germs
62
What is Avoidance (in relation to OCD)?
People with OCD may also attempt to reduce anxiety by keeping away from situations that trigger it. Eg. people who wash compulsively may try to avoid coming into contact with germs completely. Avoidance can prevent people from leading a regular life
63
What are the emotional characteristics of OCD?
. Anxiety and Distress
. Accompanying Depression
. Guilt and Disgust
64
What is meant by Anxiety and Distress (OCD)?
Both obsessions and compulsions are accompanied by strong feelings of anxiety. Obsessive thoughts are unpleasant and frightening, and the anxiety that accompanies these can be overwhelming. The urge to repeat a behaviour (a compulsion ) also creates anxiety
65
What is Accompanying depression in OCD?
OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities. Compulsive behaviour tends to bring some relief, but this is temporary
66
What is Guilt and Disgust?
OCD can also involve other negative emotions such as irrational guilt eg. over minor moral issues, or disgust which may be directed at something external (dirt) or the self.
67
What are the cognitive characteristics of OCD?
. Obsessive thoughts
. Cognitive coping strategies
. Insight into excessive anxiety
68
What are Obsessive thoughts?
This is the main cognitive feature of OCD. Reoccurring thoughts vary from person to person, but are always unpleasant eg. fears of being contaminated by germs, religious fears, impulses to hurt someone
69
What are Cognitive coping strategies?
People may respond to obsessions by adopting cognitive coping strategies to deal with them eg. praying or meditating in response to religious fears/guilt. This may help to manage anxiety, but may appear abnormal to others and distract them from everyday tasks
70
What is meant by Insight into excessive anxiety?
People with OCD are aware that their obsessions and compulsions are irrational (this is necessary for an OCD diagnosis). However they are constantly aware of the worst case scenario, experiencing catastrophic thoughts about what might happen if their anxieties were justified. They also tend to be hypervigilant, maintaining constant alertness and keeping attention on potential hazards.
71
What does the behaviourist approach say about explaining phobias?
. It emphasises the role of learning in acquiring a behaviour, especially classical and operant conditioning.
. It is geared towards explaining the behavioural aspects of phobias, rather than emotional and cognitive.
72
What is the two-process model and who proposed it?
Mowrer (1947) suggested that phobias are learned through classical conditioning and maintained through operant conditioning - a two process model.
73
How are phobias acquired through classical conditioning?
Classical conditioning involves learning through association - something we initially have no fear of (a neutral stimulus) is repeatedly paired with something we already fear (unconditioned stimulus) until we fear both and the neutral stimulus becomes a conditioned stimulus.
Watson and Rayner (1920) demonstrated this in the 'Little Albert' case.
74
What was the 'Little Albert' experiment?
Watson and Rayner (1920):
Created a phobia in 9 month old Albert, who showed no unusual anxiety at the start of the study. When shown a white rat, Albert attempted to pet it - it was a neutral stimulus. They then began to present the rat alongside a loud, frightening noise made by banging an iron bar close to Albert's ear (the noise was an unconditioned stimulus and created an unconditioned response of fear). This was done repeatedly, and over time the neutral stimulus became associated with the unconditioned stimulus. As a result, when presented with the rat on its own, Albert displayed fear. The rat was now a conditioned stimulus and produced a conditioned response of fear.
This conditioning then generalised to similar objects - when Albert was shown other furry objects such as a non-white rabbit, a fur coat and Watson wearing a Santa beard Albert displayed distress.
75
How are phobias maintained through operant conditioning?
Responses acquired through classical conditioning tend to decline over time, however phobias tend to be long-term. Mowrer explained this by operant conditioning
Operant conditioning involves learning through behaviour being reinforced (which tends to increase the likelihood of the behaviour occurring) or punishment (which decreases the likelihood of the behaviour occurring).
Mowrer suggested that whenever someone with a phobia avoids a phobic stimulus, they successfully escape the fear and anxiety they would have experienced if they had remained there. This reduction in fear is seen as a desirable consequence, reinforcing the avoidance behaviour so that it will be repeated and allowing the phobia to be maintained. This is an example of negative reinforcement.
76
What is a strength of the behaviorist approach to explaining phobias - real world application?
The two process model can be used in exposure therapies (eg. systematic desensitisation). The distinctive element of the two process model is the idea that phobias are maintained by the avoidance of the phobic stimulus. This is important in explaining why people then benefit from being exposed to a phobic stimulus - once the avoidance behaviour is prevented is ceases to be reinforced by anxiety prevention. This leads to the phobia being cured. This shows the value of the two-process model as its concepts are useful in treating phobias
77
What is a strength of the behaviourist approach to explaining phobias - research support?
There is research support for a link between bad experiences and phobias. The Little Albert study (Watson and Rayner 1920) shows how a frightening experience involving a stimulus can lead to a phobia developing around that stimulus. De Jongh et.al (2006) also supported this by showing that 73% of people afraid of dental treatment had had a traumatic experience mostly involving dentistry. In a control group of people w/out dental anxiety, only 21% had experienced a traumatic event. This supports the idea that association between a stimulus and unconditioned response does lead to the development of of a phobia.
78
What is a counter argument for Evidence/Research support - (explaining phobias)?
NOT ALL PHOBIAS APPEAR AFTER A BAD EXPERIENCE - eg. some common phobias such as snake phobias occur in populations where very few people have any experience with snakes - traumatic or otherwise. Also, not all traumatic experiences lead to phobias. This means that the association between phobias and frightening experiences is not as strong as we would expect if the behavioural theory provided a complete explanation.
79
What is a limitation of the behaviourist approach to explaining phobias - doesn't account for cognitive aspects?
Behavioural explanations such as the two-process model are geared towards explaining behaviour - in the case of phobias it explains the avoidance behaviour. However phobias aren't just avoidance responses and have significant cognitive and emotional aspects eg. irrational beliefs about phobic stimulus. The two process model explains behaviour, but doesn't offer a sufficient explanation of phobic cognitions. This means the two process model can't completely explain the symptoms of phobias.
80
What is a limitation of the behaviourist approach to explaining phobias - evolutionary explanations?
Behavioural models of phobias like the two-process model provide credible individual explanations for why people develop phobias. However there are other more general aspects of phobias that may be better explained by evolutionary theory eg. we tend to acquire phobias of things that presented a danger in our evolutionary past such as the dark. Selgiman (1971) referred to this as preparedness.
81
What two methods does the behaviorist approach offer for treating phobias?
. Systematic desensitisation
. Flooding
82
What is 'systematic desensitisation' ?
A behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning. A new, positive response is associated with the stimulus and learned eg. a feeling of relaxation - this is known as counterconditioning. 3 steps are involved in systematic desensitisation: The Anxiety Hierarchy, Relaxation, and Exposure
83
What is The Anxiety Hierarchy?
A list of situations related to the phobic stimulus that provoke anxiety, arranged from least to most frightening. It is put together by the client and therapist jointly. E.g. looking at a picture of a spider at 1 vs letting a spider crawl on your arm at 10, for a person with arachnophobia
84
What is Relaxation?
The therapist teaches the client relaxation techniques. It is impossible to feel two conflicting emotions at the same time eg. fear and calm, so the calmness prevents anxiety (reciprocal inhibition). Clients may learn to relax through meditation, mental imagery techniques, or drugs eg. Valium.
85
What is Exposure?
The client is exposed to the phobic stimulus while in a relaxed state, starting at the bottom of the anxiety hierarchy. The client can only move onto the next level of the hierarchy when they can stay relaxed in the current level of the phobic stimulus. Treatment is considered to be successful when the client can stay calm in the higher levels of the anxiety hierarchy.
86
What is 'flooding'?
A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus immediately - without a gradual build up - in order to reduce the anxiety triggered by that stimulus. Sessions are typically longer than systematic desensitisation sessions, but fewer sessions are needed.
87
What steps are involved in flooding?
. Flooding works by preventing avoidance behaviour, as the client confronts their phobic stimulus head on. The prevention of avoidance behaviour then means that the client learns the stimulus is harmless, as they remain in the presence of the stimulus, unharmed, until they are calm (in classical conditioning terms this is known as 'extinction').
. A learned response (conditioned response) of fear is extinguished when the conditioned stimulus is encountered without the unconditioned stimulus. As a result, the conditioned stimulus no longer produces the conditioned response of fear (eg. a patient afraid of dogs encounters a dog without being bitten).
. In some cases the client may achieve relaxation in the presence of the phobic stimulus as they become so exhausted by their own fear.
88
What is necessary to consider when performing flooding as a treatment for phobias?
Ethical safeguards must be in place when taking part in a flooding treatment. Clients must give fully informed consent, as it is a traumatic and emotionally difficult procedure. Typically, clients are given a choice between treatments - SD or flooding, rather than being forced into any.
89
What is a strength of systematic desensitisation - evidence for its efficacy?
There is a strong evidence base for the effectiveness of systemic desensitisation. Gilroy et.al (2003) followed 42 patients with a fear of spiders for three 45 minute systematic desensitisation sessions. At both 3 and 33 months, the systematic desensitisation group was less fearful than a control group treated by relaxation without exposure. Wechsler et.al (2019) also concluded that systematic desensitisation is effective for specific phobia, social phobia, and agoraphobia. This provides research support for systematic desensitisation as an effective treatment for people with phobias.
90
What is a strength of Systematic desensitisation - learning difficulties?
Some people requiring treatment for phobias may also have learning difficulties, however the main alternatives for systemic desensitisation i.e. flooding (which can be distressing) or cognitive therapies (which require complex rational thought) are not suitable. This means systematic desensitisation is useful as it may be the most appropriate treatment for people with learning difficulties who have phobias.
91
What is a strength of flooding - cost-effective?
Clinical effectiveness refers to how effective a therapy is at tackling symptoms. However when we provide therapies in health systems such as the NHS it is necessary to consider their cost effectiveness (if it is clinically effective and not expensive). Flooding can work in as little as one session, as opposed to systematic desensitisation which may require 10 sessions to get the same result. Even allowing for a longer session eg. 3 hours, flooding is still more cost-effective. This means more people can be treated at the same cost as with flooding or other therapies - potentially even cheaper.
92
What is a counterargument for the cost effective argument - flooding?
. SYSTEMATIC DESENSITISATION CAN BE DONE IN VIVO OR IN VITRO - While traditional systematic desensitisation involves exposure to phobic stimulus in a real world setting (in vivo) it can be done through the form of virtual reality or imagining the hierarchy (in vitro). In vitro exposure can be used to avoid dangerous situations eg. when dealing with a fear of heights, and can also be cost-effective as the psychologist and client don't need to leave the consulting room, pay for the use of a phobic stimulus etc. In this sense, systematic desensitisation can be more cost effective than flooding, where the direct nature of the therapy may mean real life exposure is more necessary.
---- HOWEVER Wechsler (2019) ---- suggested VR exposure may be less effective than real life exposure as it lacks realism.
93
What is a limitation of flooding - it can be traumatic?
Flooding is a highly unpleasant experience, as confronting a phobic stimulus in such an extreme form provokes anxiety. Schumacher et.al (2015) found that participants and therapists both rated flooding as being significantly more stressful than systematic desensitisation. This raises ethical concerns, as psychologists are knowingly causing emotional harm to their patients (however this is less serious of an issue if they have obtained informed consent). More importantly, the traumatic nature of flooding means that it is more likely that participants will make use of their right to withdraw from the therapy. This means attrition rates will be higher for Flooding than systematic desensitisation. This may mean that therapists avoid using this treatment.
94
Outline the cognitive approach to explaining depression :
The cognitive approach suggests that depression is caused by negative thought patterns and beliefs. They suggest that people with depression have a tendency to interpret events, in a negative way, leading to negative thoughts and feelings. It is based on the work of Ellis (1962) and Beck (1967)
95
What is Beck's theory and the negative triad?
Beck (1967) suggested that a persons cognitions create vulnerability that can lead to depression. He outlined 3 parts to this vulnerability.
. FAULTY INFORMATION PROCESSING - Where depressed people attend to the negative aspects of a situation and ignore the positive, tending towards black and white thinking.
. NEGATIVE SELF-SCHEMA - A self schema is the package of information people have about themselves, developed through past experience. Someone with a negative self-schema interprets all incoming information about themselves in a bad way.
. THE NEGATIVE TRIAD - Beck suggested that people develop dysfunctional views of themselves due to 3 types of naturally occurring negative thinking
- Negative view of the self - Enhances any existing depressive
feelings as they confirm the existing emotions of low self-
esteem
- Negative view of the world - Creates the impression that there
is no hope in life
- Negative view of the future - Reduce hope that life might get
better, enhancing depression.
The negative triad is maintained by cognitive biases and negative self-schemas
96
What is Faulty information processing?
Where depressed people attend to the negative aspects of a situation and ignore the positive, tending towards black and white thinking.
97
What is a Negative self-schema?
A self schema is the package of information people have about themselves, developed through past experience. Someone with a negative self-schema interprets all incoming information about themselves negatively
98
What is the Negative triad?
Beck suggested that people develop dysfunctional views of themselves because of 3 types of naturally occurring negative thinking:
. Negative view of the self - e.g. 'I am a failure'. Enhances any existing depressive feelings, as they confirm the existing emotions of low self-esteem
. Negative view of the world - e.g. 'the world is a cold place'. Creates the impression that there is no hope anywhere
. Negative view of the future - e.g. 'the economy will never improve'. Reduces hope that life might get better, enhancing depression.
The negative triad is maintained by cognitive biases and negative self-schemas
99
What is Ellis' ABC model?
Ellis (1962) proposed that good mental health is the result of rational thinking (thinking in ways that allow people to be happy and free from pain). To Ellis, conditions such as anxiety and depression are a result of irrational thought (thoughts that interfere with us being happy and pain free). Ellis proposed the ABC model, which aims to explain how irrational thoughts affect behaviour and emotions.
100
What does 'A' stand for in Ellis's ABC model?
A = Activating Event - Ellis focused on situations where irrational thoughts are triggered by external events. He said we get depressed when we experience negative events and these trigger irrational beliefs eg. a friend ignoring you in the corridor at school
101
What does 'B' stand for in Ellis's ABC model?
B = Beliefs - Ellis identified a range or irrational beliefs eg. the belief you must always achieve perfection = musterbation, the belief that life is always meant to be fair = utopianism
Your belief is your interpretation of an event, which can be either rational or irrational. eg. a rational belief about the situation would be that your friend is busy and didn't see you, an irrational belief would be that your friend hates you and doesn't want to talk to you
102
What does 'C' stand for in Ellis's ABC model?
C = Consequences - Rational beliefs lead to healthy emotional outcomes and behaviours eg. I will check up on my friend later, while irrational beliefs lead to unhealthy emotional outcomes and behaviours, including depression eg. my friend clearly hates me, I will stop speaking to them. Alternatively, if a person they must always succeed and fails at something, this can trigger depression
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What is a strength of Beck's negative triad - research support?
There is supporting research for the existence of the concept of 'cognitive vulnerability' (ways of thinking which may predispose someone to becoming depressed eg. faulty information processing, negative self-schema). Clark and Beck (1999) concluded that not only were these cognitive vulnerabilities more common in depressed people. but they preceded the depression. This was confirmed in research by Cohen et.al (2019), which tracked the development of 473 adolescents, regularly measuring cognitive vulnerability. Researchers found that showing cognitive vulnerability predicted later depression. This shows a clear association between cognitive vulnerability and depression, and in turn between Beck's theory and depression, increasing its reliability.
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What is a strength of Beck's negative triad - real world application?
Beck's cognitive model has applications in the screening and treatment of depression. Cohen et.al (2019) concluded that assessing cognitive vulnerability allows psychologists to screen young people in order to identify those most at risk of developing depression in the future, so that they can be monitored. Understanding cognitive vulnerability can also be applied in cognitive behaviour therapy, which work by altering the cognitions that make people vulnerable to depression, making them more resilient to negative life events. This means that understanding cognitive vulnerability is useful in multiple aspects of clinical practice. As such, it has positive social implications
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What is a limitation of Beck's negative triad - emphasis on cognition?
While Beck's theory is valuable in predicting the onset of depression and explaining why it may occur, it doesn't offer an answer for many behavioural and emotional aspects of depression eg. extreme anger, self-harming behaviour, delusions. As such, it can be seen as an incomplete explanation.
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What is a strength of the ABC model - real world application?
A strength of Ellis' model is that is has real world value due to it's role in the psychological treatment of depression. Ellis' approach to cognitive therapy is called rational emotive based therapy, and is based on the idea that by vigorously arguing with the depressed person, the therapist can alter the irrational beliefs that make them unhappy. There is some evidence to support the idea that REBT can change negative beliefs and reduce symptoms of depression (David et.al 2018). This means that REBT, and by extension the ABC model, have real world applications.
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What is a limitation of the ABC model - partial explanation?
The ABC model can be seen as only explaining reactive depression while ignoring endogenous depression. There seems to be no doubt that depression is often triggered by life events (Ellis' activating events) - cases like this can be referred to as reactive depression. However many cases of depression are not traceable to life events and it isn't obvious what leads the person to become depressed. This type of depression is sometimes referred to as endogenous depression. Ellis' ABC model is less useful in explaining this kind of depression, meaning that the model can only be applied to certain types of depression and is therefore only a partial explanation - it has limited applicability.
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Outline the cognitive approach to treating depression (cognitive behaviour therapy) :
Cognitive Behavioural Therapy (CBT) is the most commonly used psychological treatment for depression. It involves both cognitive and behavioural techniques:
. The cognitive element - Begins with an assessment in which client and therapist clarify the patients problems and identify goals. It aims to deal with irrational and negative thoughts that lead to depression
. The behavioural element - aims to test their beliefs through behavioural experiments, and put more effective behaviours in place.
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Outline the components involved in CBT
. Initial assessment
. Goal setting
. Identifying negative/irrational thoughts and challenging these
. Using Beck's cognitive therapy or Ellis' REBT
. Homework
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What is Beck's cognitive therapy?
. Initial assessment - The therapist helps the client to identify negative thoughts about their self, world and future (the negative triad). Once identified these thoughts can be challenged, the central component of the therapy
. Goal setting - Client and therapist agree on a set of goals and a plan to achieve these goals
. The client as a scientist - Client and therapist work together to challenge these irrational thoughts by discussing evidence for and against them - they are encouraged to assess the validity of their negative thoughts, and may be set homework to challenge them. They may also be set homework to record events when they enjoyed an event, when someone was nice to them etc. - then, if in future sessions the client says no one is kind to them the therapist can use this as evidence to prove that the clients statements are incorrect.
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What is Ellis' REBT (rational emotive behaviour therapy)?
Rational Emotive Behaviour Therapy extends Ellis' ABC model to include D (dispute) and E (effect/effective) - ABCDE. The central aim of the therapy is to identify and challenge irrational thoughts through disputes
. Eg. A client states that everything in the world is unfair
. The therapist identifies this as utopianism and argues against this, stating that it is an irrational belief.
. The intended effect of these arguments is to break the link between negative life events and depression
Different types of dispute include:
. Logical dispute
. Empirical dispute
The therapist may set the client homework so that they can begin to identify their own irrational beliefs and prove them wrong. As a result, their beliefs begin to change.
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What types of dispute are used in REBT therapy?
. Logical dispute - where the therapist questions the logic of a persons negative beliefs
. Empirical dispute - where the therapist seeks evidence for the persons negative beliefs.
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What is behavioral activation?
As individuals become depressed, they tend to increasingly avoid difficult situations, leading to them becoming isolated, which maintains or worsens their symptoms. The goal of behavioral activation is to work with depressed individuals in order to gradually decrease their avoidance and isolation, increasing their engagement in activities proven to improve mood eg. exercise
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What is a strength of cognitive behaviour therapy - evidence for its effectiveness?
There is a large body of evidence supporting the effectiveness of cognitive behaviour therapy as a treatment for depression. For example March et.al (2007) compared CBT to antidepressant drugs, as well as a combination of both treatments when treating 327 adolescents. After 36 weeks 81% of the antidepressant group, 81% of the CBT group, and 86% of the combined group had improved. This shows that CBT was just as effective as antidepressants on its own, and even more so when used in combination with drugs. Furthermore, CBT is normally a brief therapy requiring about 6-12 sessions, so is cost-effective. This means CBT is widely seen as the first choice treatment in public healthcare as it is just as clinically effective as other treatments such as antidepressants, while being more cost effective.
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What is limitation of cognitive behaviour therapy - learning disabilities and severe cases?
A limitation of CBT is that it may not be as effective in the case of patients with severe depression or learning disabilities. Depression may be so severe that clients cannot motivate themselves to engage in the cognitive work of CBT, or may be unable to pay attention in a session. Equally, patients with learning disabilities may be unable to cope with the complex rational thought involved in CBT, making it an unsuitable treatment. Sturmey (2005) suggests that in general any form of psychotherapy isn't suitable for people with learning disabilities, including CBT. This suggests CBT may only be appropriate for a specific range of people with depression, limiting its applicability.
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What is a counterpoint to the learning difficulty/severe case argument - CBT?
There is some evidence to challenge this. Lewis and Lewis (2016) concluded that CBT was as effective as antidepressants and behavioral therapy in treating severe depression, white Taylor et.al (2008) argued that when used appropriately CBT was effective for people with learning difficulties.
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What is a limitation of cognitive behavioural therapy - high relapse rates?
A limitation of CBT as a treatment for depression is the high relapse rates associated with it. Though it is effective in tackling the symptoms of depression, there are concerns over how long the benefits last. Relatively few early studies looking at CBT as a treatment for depression looked at its long term effectiveness. Some more recent studies suggest that the long term outcomes are not as good as once assumed eg. Shehzad Ali et.al (2017) assessed depression in 439 clients every month for 12 months following a course of CBT. 42% of participants relapsed into depression within 6 months of treatment, and 53% relapsed in 12 months. This may mean that CBT needs to be repeated periodically in order to be an effective treatment, reducing the cost-effective benefits of it.
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Outline the biological approach to explaining OCD
The biological approach to explaining OCD argues that there is a genetic component to OCD which predisposes some people some people to the illness. It contains genetic and neural components
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What is the genetic explanation for OCD?
. It is believed that there is a genetic component to OCD, with certain inherited genes creating vulnerabilities to the disorder. LEWIS (1936) studied his OCD patients and found that 37% had parents with OCD and 21% had siblings with OCD, suggesting it runs in families. Key features of the genetic explanation for OCD include:
. Candidate genes
. OCD is Polygenic
. OCD is Aetiologically Heterogenous
. Diathesis stress model
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What are Candidate genes in relation to OCD?
Candidate genes are specific genes which have been identified as creating vulnerabilities for OCD. These have been linked to the serotonin system (eg. the gene 5HTI-D beta which is implicated in the transmission of serotonin across the synapse)
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What is meant by the idea that OCD is polygenic?
It is believed that OCD is caused by a combination of several genes rather that one single 'OCD gene' - TAYLOR (2013) analysed findings of previous studies and found that up to 230 different genes may be involved in OCD
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What is meant by the idea that OCD is aetiologically heterogenous?
The origins of OCD varies from person to person, with one combination of genes causing OCD in one person and another combination causing it in another.
There is also evidence to suggest that different types of OCD may be the result of particular genetic variations eg. hoarding disorder and religious obsession
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What is the Diathesis-stress model in relation to OCD?
The genetic explanation suggests that certain genes create a vulnerability for OCD, however this doesn't mean a person will develop the disorder for certain - environmental triggers/stress may be necessary to trigger the condition - an interaction of biology/ environment or nature/nurture
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What is the neural explanation for OCD?
The idea that OCD is caused by abnormal brain structures and neurotransmitter activity. Key elements of the neural explanation for OCD include:
. The role of serotonin
. Decision making systems
. Left parahippocampal gyrus dysfunction
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What is the role of serotonin in OCD?
One explanation suggests that low levels of the neurotransmitter serotonin (believed to help regulate mood) prevents a normal transmission of mood relevant information which may lead to low moods and may affect other mental processes.
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How are decision making systems associated with OCD?
Another explanation suggests that some cases of OCD eg. hoarding disorders may be associated with impaired decision making. This in turn may be associated with abnormal functioning of the lateral frontal lobes, which are associated with logical thinking and making decisions
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What is 'left parahippocampal gyrus dysfunction'?
There is also evidence suggesting that the left parahippocampal gyrus associated with processing unpleasant emotions may function abnormally with OCD
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What is a strength of the biological approach to explaining OCD - evidence base?
One strength of the biological approach to explaining OCD is the existence of supporting evidence. Antidepressants that work purely based on theories regarding serotonin are effective in reducing OCD symptoms, suggesting that it is at least partially involved in OCD. Also OCD symptoms form part of conditions known to be biological in origin eg. the degenerative brain disorder Parkinson's disease, (Nestadt 2010). If biological disorders produce OCD symptoms, we can assume biological processes underlie OCD, giving credence to the biological explanation of OCD and making it more reliable.
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What is a limitation of the biological approach to explaining OCD - nature vs nurture?
There is strong evidence to support the idea that genetic variations can create vulnerabilities for OCD, however this approach largely ignores the influence of environmental risk factors which can trigger or increase the risk of developing OCD. Cromer (2007) found that over 50% of OCD clients in their sample had experienced a traumatic event, and OCD was more severe in those with one or more traumas. This means the genetic explanation only provides a partial explanation for OCD, so is limited in its value.
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What is a limitation of the biological approach to explaining OCD - exclusivity of the serotonin-OCD link?
Many people with OCD also experience clinical depression, which likely disrupts the action of serotonin. This co-morbidity leaves us with a logical problem in terms of using serotonin functioning as an explanation for OCD, as we can't be sure that OCD is related to abnormal functioning. It may be that serotonin activity is disrupted in people with OCD because they have depression as well. This means the serotonin explanation, and by extension aspects of the biological explanation, may be irrelevant.
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Outline the biological approach to treating OCD
The biological approach to treating OCD aims to restore biological imbalances eg. imbalances of serotonin using drug treatments, based on the assumption that chemical imbalances are the root cause of OCD. Examples of drug treatments include the use of SSRI's, SNRI's and Tricyclics
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What are SSRI's?
. Selective Serotonin Reuptake Inhibitors eg. Prozac and Fluoxetine
. They are a form of anti-depressants which work by preventing the reabsorption of serotonin by the pre-synaptic neuron. This is based on the idea that low levels of serotonin is a result of serotonin not being absorbed by the post-synaptic neuron when travelling across the synapse.
. By preventing the reabsorption of serotonin, the level of serotonin available in the synapse is increased, meaning more is received by the post-synaptic neuron to continue to stimulate it
. Anti depressants reduce the anxiety and improve the low moods associated with OCD
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Give an example of an SSRI
Eg. Fluoxetine
. A typical dose is 20mg, although this can be increased if it isn't benefitting the individual
. It typically takes 3-4 months of daily use for SSRI's to have an impact on and improve symptoms
. Available in liquid or capsule form
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Why and how are SSRI's used alongside other treatments?
Drugs are often used in combination with Cognitive Behavioural Therapy (CBT) to treat OCD. The drugs reduce a patients emotional symptoms, such as feeling anxious or depressed, allowing them to engage more effectively with the therapy.
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Outline alternative treatments to SSRI's
If Selective Serotonin Reuptake Inhibitors prove ineffective, Tricyclics or SNRI's may be used instead
. Tricyclics - An older type of antidepressant eg. Clomipramine. They act on various symptoms including the serotonin system, and has similar effects as SSRI's, however their side-effects tend to be more severe so it is kept as a last resort
. Serotonin Noradrenaline Reuptake Inhibitors (SNRI's) - More recent form of anti-depressant, and like Tricyclics they are a second line of defense for patients who don't respond to SSRI's. They increase levels of serotonin and noradrenaline
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What is a strength of the biological approach to treating OCD - evidence base?
There is clear evidence to show that SSRI's reduce the severity of symptoms in OCD sufferers. Soomro (2009) reviewed 17 studies comparing SSRI's and placebos in treating OCD, and all 17 studies showed a significantly better outcome for SSRI's. Typically, symptoms reduce for around 70% of sufferers with SSRI's, and the remaining 30% can be helped with alternative drugs. CBT etc.. So the approach is valuable in improving the lives and symptoms of OCD sufferers, and so has real world benefits and application
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What is a strength of the biological approach to treating OCD - cost-effective and non-disruptive?
Drug treatments tend to be cheaper than psychological treatments. Thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one therapy session. Therefore using drugs to treat OCD is therefore beneficial for public health systems like the NHS as it represents a good use of limited funds. Also, SSRI's are non-disruptive when compared with therapy, as sessions can be time consuming. This leads to drugs being a popular treatments with patients and doctors, so the theory has practical value and real world applicability
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What is a limitation of the biological approach to treating OCD - side effects?
A small minority of people (around 30%) will not benefit from taking SSRI's, meaning they have to take SNRI's or Tricyclics, which typically have more severe side effects eg. side effects of Tricyclics include erection problems, weight gain, and in rare cases aggression and heart issues. Some patients may experience blurred vision, indigestion, loss of sex drive etc.. While these side effects are typically temporary, they can sometimes be long-lasting, and in all cases may be distressing for people. As such, some people have a reduced quality of life as a result of drug treatments, and others may refuse to take them altogether, limiting their efficacy and real world value.
