Psychopathology: Paper 1

Question 1

Deviation from social norms

Answer 1

• A person is abnormal when their behaviour does not follow the social norms of society.

Question 2

How does defining abnormality as a deviation from social norms help society intervene? (1)

Answer 2

• Allows us to know when to intervene when people cannot help themselves
• As we can identify behaviours that deviate from the norms of society.
• For example, if we see that a person has sudden weakness on one side of the body and difficulty understanding speech or trouble speaking they are suffering from a stroke and we should call the ambulance immediately.
• Ensures they receive treatment for their abnormal behaviour

Question 3

How does defining abnormality as a deviation from social norms help society? (1)

Answer 3

• Take into account the effect that behaviours have on others.
• According to this definition, abnormal behaviour is behaviour that damages others.
• Social rules are established to help people live together and integrate with society.
• For example, laughing at someone’s death at a funeral is wrong and educating a person why it is wrong through the unwritten social norms helps them fit into society.
• Preventing any behaviours that can cause damage to society such as violence.

Question 4

How can cultural differences limit the definition of abnormality in terms of deviation from social norms? (1)

Answer 4

• In different societies, there are different cultures.
• Cultures have different norms meaning there is no universal norm.
• For example, in Saudi Arabia, it is completely illegal to consume alcohol whereas in London it is perfectly legal to consume alcohol at 18 years of age or more.

Question 5

Why do social norms changing after time limit the definition of abnormality in terms of deviation from social norms? (1)

Answer 5

• What is considered socially acceptable now, may not have been in the past.
• For example, homosexuality.
• Therefore, there is no clear, steady definition of deviance as it can change over time.

Question 6

What are ethical implications for defining abnormality in terms of deviation from social norms? (1)

Answer 6

• There are ethical implications from defining behaviour that deviates from social norms as ‘abnormal’.
• It can lead to society excluding and stigmatising people who do not fit the norm.
• As a result, people who go against the norm can be seen as mentally ill.

Question 7

Deviation from statistical frequency is

Answer 7

behaviour that is statistically infrequent.

This means that the behaviours are very rare as they are found in a very few people compared to the rest of the population.

For example, these abnormal behaviours are found at the extreme ends of a normally distributed curve in a bell curve graph.

Question 8

What is a strength of having an agreed cut off point? (1)

Answer 8

5% of the population that fall more than two standard deviations from the mean are classified as abnormal.

This means abnormalities are easier to diagnose and thus it is easier to collect data.

Question 9

What are real life applications of this definition of abnormality? (1)

Answer 9

A strength of the statistical defnition is that it has a real-life application in the diagnosis of intellectual disability disorder.

There is therefore a place for statistical infrequency in thinking about what are normal and abnormal behaviours and characteristics.

Actually all assessment of patients with mental disorders includes some kind of measurement of how severe their symptoms are as compared to statistical norms (as distinct from social norms). Statistical infrequency is thus a useful part of clinical assessment.

Question 10

What are infrequent characteristics that can actually be desirable? (1)

Answer 10

Very few people have IQs over 150, yet we would not want to suggest that having high IQ is abnormal.

There are also frequent characteristics that are undesirable.

For example, having an eating disorder is common but is still viewed as undesirable.

Thus, using statistical infrequency to define abnormality means we are unable to tell the difference between desirable and undesirable behaviour.

Question 11

How can cultural relativism limit this definition of abnormality? (1)

Answer 11

Another problem with using deviation from social norms to define behaviour as abnormal is that social norms vary tremendously from one generation to another and from one community to another.

This means, for example, that a person from one cultural group may label someone from another culture as behaving abnormally according to their standards rather than the standards of the person behaving that way.

For example, hearing voices is socially acceptable in some cultures but would be seen as a sign of mental abnormality in the UK.

This creates problems for people from one culture living within another culture group

Question 12

What is failure to function adequately?

Answer 12

It means not being able to cope with everyday living.

Not functioning adequately may cause distress and suffering for the individual and may cause distress for others.

For example, people may lack the ability to function normally in their everyday life such as being content with not having showers or playing games all day.

If this does not cause distress to oneself or others, we can propose and suggest ‘abnormality’.

Question 13

What are the characteristics of failure to function adequately?

Answer 13

• Causing distress to one self and others
• Psychotic Behaviour
• Lack of goal oriented behaviour

These are barriers which prevent sufferers from living normally in their day-to-living.

Question 14

Why can labelling limit this definition of abnormality? (1)

Answer 14

When we make a judgement that someone is failing to cope we may end up giving them a label that can add to their problems.

For example, it would be very ‘normal’ to get depressed after the loss of a job, home or relationship and suffer from being unable to function adequately.

Someone in that position might well have benefitted from psychological help. However, future employers, partners and
organisations may attach a permanent label to that person.

Question 15

Real life applications (1)

Answer 15

Led to the development of the global assessment functioning scale: score of 1-100 of how well one is coping based on symptoms that affect their day to day living.

Question 16

How can a patient’s perspective be a strength of this definition of abnormality? (1)

Answer 16

A strength of failure to function adequately is that it does attempt to include the subjective experience of the individual.

It may not be an entirely satisfactory approach because it is difficult to assess distress, but at least this definition acknowledges that
the experience of the patient (and/or others) is important.

In this sense the failure to function adequately definition captures the experience of many of the people who need help. This suggests that failure to function adequately is a useful criterion for assessing abnormality.

Question 17

How can failure to function adequately depend on who makes the judgement? (1)

Answer 17

In order to determine ‘failure to function adequately’ someone needs to decide whether this is actually the case.

Although there are people who are distressed about being unable to cope with everyday living, there are some people who are content with the situation they are in or may not be aware that they are coping.

It is others who identify and judge their behaviour as abnormal.

Question 18

Is it simply a deviation from social norms? (1)

Answer 18

In practice it can be hard to say when someone is really failing to function and when they are just deviating from social norms.

We might think that not having a job or a permanent address is a sign of failure to function adequately. But then what do we say about people with alternative lifestyles, who choose not to have those things such as for example bohemians who like to live in a caravan?

If we treat these behaviours as ‘failures’ of adequate functioning, we risk limiting personal freedom and discriminating against minority groups.

Question 19

What is deviation from ideal mental health?

Answer 19

is defined as experiencing poor mental wellbeing.

Jahoda suggested characteristics of ideal mental health such as integration and self attitudes. For example, integration means the ability to cope with stressful situations and having a good self attitude is having high self-esteem and a strong sense of identity.

Deviation from ideal mental health according to Jahoda is defined as the absence of these characteristics. People who lack these characteristics are considered ‘abnormal’.

Question 20

What is the PRAAAE acronym to remember all 6 characteristics of abnormality?

Answer 20

P - Positive attitude towards oneself
R - Resisting stress
A - Autonomy
A - Accurate Perception of Reality
A - Self-Actualisation
E - Environmental Mastery

Question 21

How can the approach being positive be a strength of this definition of abnormality? (1)

Answer 21

Deviation from mental health offers an alternative perspective on mental disorder by focusing on the positives (desirable characteristics) rather than negatives.

Her ideas, despite not being taken up by mental health professionals, have had some influence with the ‘positive psychology’ movement, which focuses on human strengths and virtue.

Question 22

A strength of deviation from ideal mental health is that it is very comprehensive (1)

Answer 22

• It covers a broad range of criteria for mental health such as emotional, cognitive and behavioural factors.
• This definition stresses a positive approach to mental health by allowing acknowledgement of desirable traits that help define abnormality.
• The sheer range of factors covered in Jahoda’s definition makes it a good tool for thinking about mental health.

Question 23

A strength of deviation from mental health is that the definition allows individuals and professionals to target areas of dysfunction (1)

Answer 23

• For example when a person does not meet a specific criteria such as having distorted thinking, this provides a point of development as clear goals and support are provided the individual may be able to achieve ideal mental health.
• This could be important when treating different types of disorders, such as focusing upon specific problem areas a person with depression has.

Question 24

Deviation from ideal mental health’s criteria is culture bound (1)

Answer 24

• If this is used with people of non-Western or non middle class, there is a likely chance of finding a higher abnormality.
• Jahoda’s classification is specific to Western European, making it cultural bound.
• For example, self-actualisation is relevant to members of individualist cultures, but not for collectivist cultures where people strive for the greater of good of community instead of self goals.

Question 25

How can having an unrealistic criteria be a limitation of this definition of abnormality? (1)

Answer 25

It is impossible for any individual to achieve all of the ideal characteristics all of the time.

For example, a person might not have a good self attitude but is the ‘master of his environment.’

Therefore, lacking some characteristics of ideal mental health does not indicate abnormality.

Question 26

What is a phobia?

Answer 26

An extreme and irrational fear of an object or situation

Question 27

What is the first symptom of a phobia?

Answer 27

Persistent fear of a specific stimulus.

Question 28

What is the second symptom of a phobia?

Answer 28

Irrational beliefs about the feared stimulus.

Question 29

What is the third symptom of a phobia?

Answer 29

Avoidance of the feared stimulus.

Question 30

What is OCD?

Answer 30

OCD is classified as an anxiety disorder.

Question 31

What are the two main components of OCD?

Answer 31

Obsessions are persistent thoughts that cause anxiety and distress.

Compulsions are repetitive behaviours (rituals) that temporarily relieve the distress and anxiety.

Question 32

What is depression?

Answer 32

Depression is experiencing a depressed or sad mood state for a long period of time.

Question 33

What are the seven symptoms of depression

Answer 33

• Low Mood
• Loss of Pleasure
• Irrational Negative Beliefs
• Difficulty concentrating
• Change in appetite
• Change in sleep patterns
• Social Withdrawal

Question 34

What are the criteria for being diagnosed with major depression?

Answer 34

• Experienced at least 5/7 of the symptoms
• Experienced a low mood or loss of pleasure (emotional symptom)
• Prolonged period of 2 weeks or more

Question 35

What is a depressive episode?

Answer 35

When a person experiences a period of low mood, which lasts for at least one week, this is called a depressive episode.

Question 36

What is a manic episode?

Answer 36

When a person experiences a period of high mood, which lasts for at least one week, this is called a manic episode.

Question 37

What is manic depression? (Bipolar disorder)

Answer 37

When a person cycles between depressive episodes and manic episodes, this is called manic depression.

Question 38

What is the two-process model in terms of classical conditioning?

Answer 38

• Phobias are acquired through classical conditioning
• Fear is developed of a neural stimulus alongside an unpleasant unconditioned stimulus.
• Association is formed between neutral stimulus and unpleasant unconditioned stimulus
• Eventually, through repeated pairing, the neutral stimulus becomes a conditioned stimulus, eliciting a conditioned response - fear.

Question 39

What is the two-process model in terms of operant conditioning

Answer 39

• This is maintained through operant conditioning
• Through avoidance of a specific feared stimulus, an individual’s feelings of fear and anxiety is removed.
• As a result through avoidance of a punishment (encountering the feared stimulus), this behaviour is negatively reinforced, increasing the likelihood that this behaviour is repeated.

Question 40

What happened in the Little Albert Experiment? (1)

Answer 40

A03:

For example, Watson and Rayner (1920) paired an initially neutral stimulus (a white rat) with an unconditioned stimulus (a loud noise).

This produced the unconditioned response of fear in a baby known as Little Albert. After making this pairing four times, Little Albert produced a conditioned fear response when they presented him with the rat in the absence of the UCS.

This demonstrated that a fear response to an initially neutral stimulus could be classically conditioned.

Question 41

What did Barlow and Durand found?

What did Sue et al & Ost say about this? (3)

Answer 41

A03

• Found evidence that phobias are maintained through operant conditioning.
• 50% of participants could recall a traumatic event that caused their driving phobias.
• This is due to the association of the fear stimulus (car) with the traumatic event.
• Moreover, of those 50%, many have not driven since, providing evidence of operant conditioning, due to negative reinforcement by avoidance of driving.

A03

However, some phobias are not caused by traumatic events, 50% in Barlow and Durand’s experiment could not recall a traumatic event that caused their driving phobia suggesting that different phobias may be the result of different processes.

For example, Sue et al found that agoraphobics were most likely to explain their disorder in terms of a specific incident whereas arachnophobics were most likely to cite modelling as the cause.

A03:

However, Ost argues that the reason that not everyone who has a phobia can recall an incident, it is possible that such traumatic incidents did happen, but has since been forgotten as it has been repressed into the subconscious by the human defence mechanisms

Question 42

What did Cook and Mineka suggest about the function of phobias? (1)

Answer 42

A03

Attempted to condition the fear of stuffed animals into monkeys raised in captivity.

He found he could condition fear of animal such as crocodiles and snakes, which may have been threatening in the evolutionary past, but was unable to condition fear for stuffed rabbits.

This suggests that there is a preparedness to be afraid.

This preparedness theory of phobia means that humans are biological prepared to learn to fear objects and situations that threatened the survival of the species throughout its evolutionary history, which may have served a survival function.

Question 43

What about the cognitive aspects of phobias? (1)

Answer 43

A03:

• One problem with explaining phobias as a learned behaviour is that it ignores the cognitive aspects of the phobia’s development.
• For example, a person who thinks that they might die if they get trapped in a lift may become extremely anxious and this may trigger a phob ia of lifts.
• This shows that irrational thinking is also involved in the development of phobias, and could explain why cognitive therapies can be more successful than behaviour therapies in treating phobias.

Question 44

Research support for social learning (1)

Answer 44

A03:

• Another strength of the behavioural approach is the support for social learning. In an experiment by Bandura and Rosenthal (1966) a model acted as if he was in pain every time a buzzer sounded.
• Later on, those participants who had observed this showed an emotional reaction to the buzzer, demonstrating an acquired ‘fear’ response.

Question 45

Phobia does not develop after a traumatic incident all the time. (2)

Answer 45

A03:

• Another limitation of the two-process model is that a phobia does not always develop after a traumatic incident.
• For example, Di Nardo et al. (1988) found that not everyone who is bitten by a dog develops a phobia of dogs.

The diathesis-stress model says we inherit a genetic vulnerability for developing mental disorders, but this will only become apparent if it is triggered by a life event, such as being bitten by a dog.

This suggests a dog bite will only lead to a phobia in people with this vulnerability.

Question 46

What is flooding?

Answer 46

• A treatment in which a patient is exposed to their worst fear. Then, they are encouraged to stay near their phobia and confront it.
• Prevents avoidance of feared stimulus
• Eventually, the patient’s persistent fear and anxiety starts to decrease as they learn that their conditioned stimulus does not lead to an unconditioned stimulus.
• As a result, this association between a conditioned stimulus and unconditioned stimulus response extinguishes, no longer leading to a conditioned response. Therefore, their anxiety and fear disappears completely.

Question 47

Research support for flooding (1)

Answer 47

• Kaplan and Tolin (2011) found that 65% of patients with a specific phobia who were given a single session of flooding showed no symptoms of specific phobia 4 years later.

Question 48

Flooding effectiveness for social phobias (1)

Answer 48

• Flooding is highly effective for specific phobias however it appears less effective for more complex phobias such as social phobias. This may be because social phobias have cognitive aspects (e.g. sufferers experience unpleasant thoughts about social situations).

Question 49

Explain AO3 of behavioural approach to treating phobias

Hint: Symptom Substitution

(1)

Answer 49

A common criticism of behavioural therapies, including flooding, is that they only mask symptoms and do not tackle the underlying causes of mental disorders like phobias.

This is called symptom substitution, i.e. as one symptom gets better another appears or gets worse because the underlying anxiety which is the real cause of the phobia is still there.

Question 50

What is systematic desensitisation?

Answer 50

There are three stages:

• Fear hierarchy: a list of least to most feared stimuli created.
• Relaxation techniques
• Exposed to these feared stimuli gradually, ensuring the patient is relaxed at each stage.

Question 51

What is a strength of behavioural therapy? (1)

Answer 51

Strengths of behavioural therapies

Behavioural therapies for dealing with phobias are generally relatively fast and require less effort on patients than other psychotherapies. For example, lack of thinking is useful for patients who lack insight into their motivations and emotions such as children with learning difficulties.

Question 52

Relaxation may not be necessary (1)

Answer 52

Success of flooding is rather due to exposure to fear and expectation of being able to cope with feared stimulus than relaxation techniques

Question 53

Individual differences in flooding (1)

Answer 53

Flooding is not for every patient as it can be a highly traumatic procedure. For example, if patients have enough, they can quit during the treatment, which reduces the ultimate effectiveness of the therapy.

Question 54

Research support for systematic desensitisation (1)

Answer 54

Brosnan and Thorpe (2006) used systematic desensitisation to treat a group of participants who suffered from technophobia (fear of interacting with modern technology). They found that the reduction in anxiety was three times greater for those participants who had treatment compared to those who did not.

Remember?

Brosnan= Bro’s Nan/Your brother’s nanny

Thorpe= Thrope Park

Question 55

Effectiveness of Systematic Desensitisation (1)

Answer 55

Research has found that SD is successful for a wide range of phobias. For example, McGrath et al found that 75% of patients with phobias respond to SD. This shows that systematic desensitisation is effective in treating phobias.

Question 56

Not appropriate for all phobias (1)

Answer 56

However, Ohman et al suggests that SD may not be effective in treating phobias that gave us an evolutionary survival advantage in the past such as the fear of dangerous animals than treating phobias which have been acquired due to personal experiences such as fear of clowns.

Ohman = Omen (like bad omen, or Omen from Valorant)

Question 57

It is acceptable to patients (1)

Answer 57

A strength of SD is that patients prefer it. Those given the choice of SD or flooding, tended to prefer SD. This is largely because it does not cause the same degree of trauma as flooding. It may also be because SD includes elements - learning relaxation techniques - that are pleasant for patients. This is reflected in the low refusal rates and low attrition rates of systematic desensitisation.

Question 58

What is the SERT gene?

Answer 58

Affects the transport of serotonin, creating lower levels of this neurotransmitter.

Having low levels of serotonin is also implicated in OCD.

Therefore, if an individual inherits specific genes such as the SERT gene from their parents, this may lead to the onset of OCD.

Question 59

How can abnormal brain circuits lead to OCD?

Answer 59

According to neural explanations of OCD, people with OCD have impaired communication between the orbitofrontal cortex (which detects a worrying stimulus and decides an action) and the basal ganglia.

This means the signals that the basal ganglia send back to the orbitofrontal cortex - which originally function to inhibit neural activity - are much weaker than usual.

As a result, the orbitofrontal cortex is less inhibited than it should be, becoming hyperactive. Therefore, this leads to symptoms and eventually the onset of OCD.

Question 60

What is a twin study?

Answer 60

Monozygotic twins share 100% of the DNA whereas dizygotic twins share 50% of the DNA.

Used to determine the likelihood that certain traits have a genetic basis by comparing concordance rates between pairs of twins.

Question 61

How can twin studies provide research evidence for biological explanations of OCD?

(1)

Answer 61

Evidence for the genetic basis of OCD is from Billet et al’s research.

He reviewed twin studies comparing the concordance rate of monozygotic and dizygotic twins with OCD.

He found the concordance rate for monozygotic twins was 68% compared to 31% in dizygotic twins.

The big difference in concordance rate between monozygotic and dizygotic twins with OCD indicates that OCD is partially genetically inherited.

Twin studies are a standard source of evidence for genetic influence.

Question 62

However, how can twin studies be flawed in terms of concordance rates?
(1)

Answer 62

However, twin studies are limited as although there is a higher concordance rate for OCD in identical than non-identical twins, the concordance rate for identical twins are never 100%, which means that environmental factors must also play a role in OCD.

Question 63

What is an alternative explanation for OCD which may be more suitable. (1)

Answer 63

A more suitable explanation for OCD may be using an interactionist approach through the diathesis stress model.

According to the diathesis-stress model, certain genes leave some people more likely (vulnerable) to suffer a mental disorder but it is not certain – some environmental stress (experience) is necessary to trigger the condition.

Therefore someone may have a genetic susceptibility to developing OCD, but only when exposed to the correct environment stressor (e.g. develop a fear of germs through a bad experience).

Question 64

What is evidence to support the Diathesis Stress Model? (1)

Answer 64

Evidence to support this comes from Cromer et al. (2007) found that over half the OCD patients
in their sample had a traumatic event in their past, and that OCD was more severe in those with
traumatic life events,

This suggests that OCD cannot be entirely genetic in origin.

Question 65

Research support for neural explanations of OCD, but what is a limit of neural explanations?

(2)

Answer 65

Menzies (2007) found an association between ability to stop a repetitive task and a decrease in grey matter in the orbital frontal cortex in participants with OCD.

Hu (2006) compared serotonin activity in 169 OCD sufferers and 253 non-sufferers, finding serotonin levels to be lower in the OCD patients.

However, neural explanations are not straightforward; there is evidence to suggest that anatomical (brain) differences are inherited and these may lead to OCD. Therefore this explanation cannot be used to fully explain OCD.

Question 66

Behavourist explanation (1)

Answer 66

A03:

The two process models can be applied to OCD. First, the initial learning occurs when a neutral stimulus such as dirt is associated with anxiety.

This association is maintained due to the anxiety provoking stimuli such as dirt being avoided.

Therefore an obsession is formed and a link is learned with compulsive behaviours such as using hand sanitiser which appear to reduce anxiety.

Question 67

We should not assume the neural mechanisms cause OCD (1)

Answer 67

A03:

There is evidence to suggest that various neurotransmitters and structures of the brain do not function normally in patients with OCD.

However, this is not the same as saying that this abnormal functioning causes the OCD.

These biological abnormalities could be a result of OCD rather than its cause

Question 68

There is some supporting evidence (1)

Answer 68

A03:

There is evidence to support the role of some neural mechanisms in OCD. For example, some anti depressants work purely on the serotonin system, increasing levels of this neurotransmitter.

The fact that these drugs are effective in reducing OCD symptoms, suggests that the serotonin system is also involved in OCD.

For example, OCD symptoms form part of a number of other conditions that are biological in origin such as Parkinson’s Disease.

This suggests that the biological processes that cause the symptoms in those conditions may also be responsible for OCD.

Question 69

Drugs are often used alongside cognitive
behaviour therapy (CBT) to treat OCD.

Answer 69

The drugs reduce a patient’s emotional symptoms, such as feeling anxious or depressed.

This means that patients can engage more effectively with the CBT.

In practice some people respond best to CBT alone whilst others benefit more from drugs like Fluoxetine. Occasionally other drugs are prescribed alongside SSRIs.

Question 70

What is drug therapy?

Answer 70

As low levels of serotonin are associated with OCD, drug therapy is designed to work in various ways to increase the level of serotonin in the brain.

SSRIs block the reuptake of serotonin at the synapse, increasing the serotonin available at the synapse.

Since serotonin is an inhibitory neurotransmitter, it causes an increase in the inhibition of neural activity in postsynaptic neruones.

As a result, this reduces the hyperactivity of neurons in the orbitofrontal cortex in people with OCD.

Consequently, this also reduces worrying signals that cause obsession and compulsions.

Question 71

Research support for effectiveness of combination of CBT and drug therapy. (1)

Answer 71

Researchers called Connor et al. found that patients who had both types of treatment combined, using SSRIs from the biological approach, and CBT from the cognitive approach, had the biggest reduction in symptoms of OCD compared to the treatments on their own.

Question 72

Some cases of OCD follow trauma (2)

Answer 72

OCD is widely believed to be biological in origin. It makes sense,
therefore, that the standard treatment should be biological.

However, it is acknowledged that OCD can have a range of other
causes, and that in some cases it is a response to a traumatic life
event

Evidence to support this comes from Cromer et al. (2007) found that over half the OCD patients
in their sample had a traumatic event in their past, and that OCD was more severe in those with
traumatic life events,

This suggests that drug therapy may only be a temporary solution and that psychological therapies that address these traumatic life events may be a more long-term effective treatment.

Question 73

Unreliable evidence for drug treatments (1)

Answer 73

Although SSRIs are fairly effective and any side-effects will probably
be short term, like all drug treatments they have some controversy
attached.

For example, some psychologists believe the evidence
favouring drug treatments is biased because the research is
sponsored by drug companies who do not report all the evidence in an attempt to maximise economic gain.

One of the more controversial adverse effects of SSRIs is the black box warning for increased risk of suicidality in children and young adults aged 18–24.

This serves as an ethical limitation as patients may be deceived and exploited financially.

Question 74

Effectiveness is supported by studies (1)

Answer 74

Soomro et al. reviewed 17 studies that investigate the effectiveness of SSRIs.

Soomro et al. found that 70% of patients treated with SSRIs experienced an improvement in symptoms.

Shows that drugs can help most patients w/ OCD

Question 75

Drugs are a relatively cheap way of treating patients (2)

Answer 75

SSRIs are quicker to be distributed and are faster to prescribe than other treatments such as therapy, which can take a long time to complete compared to drug treatments.

This means that SSRIs are more cost-effective than other forms of treatments such as therapy for health care services to provide.

Since drugs are non-disruptive, patients can simply take them and live relatively normal lives. This means that offering drugs can lead to an enhanced quality of life as patients are given independence. This has useful and positive implications on the economy as patients can return to work and no longer need to be provided with institutional care.

Question 76

Patients have to take the drug indefinitely (1)

Answer 76

Taking SSRIs is not a long term solution to treating OCD.

There is a risk of relapse of OCD symptoms if the patient was to ever stop taking their SSRI medication.

Question 77

Patients have to cope with unwanted side effects (1)

Answer 77

SSRIs block serotonin reuptakes in the whole brain, not just in the orbitofrontal cortex.

Soomro et al found that the negative side effects that people who take SSRI’s suffer from include: nausea, headaches and difficulty sleeping.

Question 78

There is evidence to suggest that although drug treatments are helpful for most people with OCD they may not be the most effective treatment available. (1)

Answer 78

Skapinakis et al (2016) carried out systematic review of outcome studies and concluded both cognitive and behavioural (exposure) therapies were more effective than SSRI’s in the treatment of OCD.

This means drugs may not be the optimum /most effective treatment for OCD.

Question 79

What is the ABC model?

Answer 79

Ellis proposed that the key to mental disorders such as depression are due to irrational beliefs.

In his ABC model, the ‘A’ refers to an activating event that is negative such as failing an exam.

B is the belief, which may be rational or irrational. For example, people with rational thoughts would think that they failed the exam because they did not revise whereas people with irrational thoughts would think that they failed because examiners made the exam hard purposefully to make them fail.

C then refers to the consequences. This means rational beliefs lead to healthy emotions (such as acceptance) whereas irrational beliefs lead to unhealthy, negative emotions such as depression.

Question 80

How did Beck categorise irrational negative beliefs into a triad?

Answer 80

• Negative beliefs about the self - such as ‘I am a failure’. These thoughts enhance existing depressive feelings as they confirm a person’s emotions of low self-esteem.
• Negative beliefs about the world - such as ‘the world is a cold hard place’ creates the impression in the individual that there is no hope anywhere in the world.
• Negative beliefs about the future - ‘I will never do good in this test.’ These thoughts reduce any hope, encourage despair and enhance depressive feelings.

Question 81

What did Beck say about negative schemas and negative cognitive bias and its relation to irrational negative beliefs.

Answer 81

According to Beck, irrational negative beliefs are caused by a person having a negative schema which is a framework built up from past experiences.

Negative cognitive bias (focus on negatives) —> irrational negative beliefs.

Question 82

Support for the role of irrational thinking (2)

Answer 82

The view that depression is linked to irrational thinking is supported by various research.

For example, Hammen and Krantz found that depressed participants made more errors in logic when asked to interpret written material than non depressed people.

In addition to this, Bates et al found that depressed people who were given negative automatic thought statements became more and more depressed showing that negative and irrational thinking leads to depression.

Question 83

Practical applications in the therapy. (1)

Answer 83

One strength to the cognitive explanation of depression is that CBT is consistently found to be the best treatment for depression, implying that thoughts had a significant impact as to reasons a person is suffering from depression.

This means that if depression is alleviated by challenging irrational thinking then this suggests thoughts had a role in depression in the first place.

Question 84

Irrational beliefs may be realistic (1)

Answer 84

Irrational beliefs may seem irrational even though they could be realistic.

For example, Alloy and Abrahmason suggest that depressive realists tend to see things for what they are compared to normal people who view the world with rose-tinted glasses.

They found depressed people were more likely to give accurate estimates of the likelihood of a disaster occuring than normal people, calling this the ‘sadder but wiser’ effect.

Question 85

People who have lower levels of serotonin are more likely to have depression (1)

Answer 85

For example, research from Zhang et al shows that the role of low levels of serotonin in depressed people and has found a gene related to this is more 10 times more common in people with depression.

Question 86

Attachment and depression (1)

Answer 86

Studies of attachment have shown that those infants that develop
insecure attachments to their parents are more vulnerable to depression in adulthood.

Insecure attachments may lead to negative cognitive schemas, encompassing beliefs such as seeing oneself as unlovable, unworthy, or helpless.

The endurance of these negative beliefs into adulthood supports the cognitive approach to explaining depression because this negative schema developed as a child has led to an irrational negative belief in adulthood.

Question 87

An interactionist approach to explaining depression may be more suitable. (1)

Answer 87

Another problem is that, as well as cognitive factors, it is very likely that genetic factors and neurotransmitters are involved in depression. Research has shown that depressed people have lower levels of serotonin. This means that neurotransmitters also play a role in causing depression, and so a diathesis-stress model could be a better explanation for depression rather than cognitive or biological explanations on their own.

Question 88

What did McGuffin et al find regarding depression in twin studies that limits cognitive explanation of depression? (1)

Answer 88

The concordance rate of major depressive disorder for MZ twins was 46% and for non-identical (DZ) twins was 20%. This shows that there is a heritability factor for major depression

Question 89

Limitations of Beck’s negative triad: Casual Relationships are Unclear (2)

Answer 89

• Most evidence linking negative thinking to depression is correlational meaning it does not indicate negative thoughts CAUSING depression.
• This means that we do not know for sure whether depression causes negative thoughts or vice-versa.
• This means we cannot establish a cause and effect relationship between negative thinking and depression.
• However, Beck has suggested and found that depression and negative thinking have a bi-directional relationship meaning that they both influence each other, showing that his negative triad theory does have validity.

Question 90

A weakness of the cognitive approach to depression is that it blames the patient (1)

Answer 90

For example, the cognitive approach suggests disorders are simply in the patient’s mind (e.g. an individual is depressed because they think in a negative automatic way) this could lead to situational factors (e.g. family) being overlooked.

This is a problem because it may be unhelpful to place a large burden of blame on a person prone to negative thoughts and depression, as a result, if individuals feel responsible for their own abnormality this could lead to delays in treatment (the individual may not have the motivation to treat a disorder that they feel ultimately responsible for).

Question 91

What is cognitive behavioural therapy and what are the steps of CBT?

Answer 91

• Attempts to remove irrational negative beliefs that caused depression

Steps in Cognitive Behavioural Therapy:

First, the therapist encourages the patient to identify their negative beliefs about the world, self and future.

Second, the therapist challenges these beliefs.

Third, the patient is set homework to gather evidence to test their hypothesis.

Fourth, the therapist and patient evaluate the evidence together in the next sessions.

Question 92

What is behavioural activation?

Answer 92

Alongside the purely cognitive aspects of CBT the therapist may also work to encourage a depressed patient to be more active and engage in enjoyable activities.

This behavioural activation will provide more evidence for the irrational nature of beliefs

Question 93

Research support for effectiveness (1)

Answer 93

Ellis claimed a 90% success rate for REBT, taking an average of 27 sessions to complete the treatment. However, he recognised that the therapy was not always effective as some clients did not put their revised belief into action.

Question 94

Individual differences (2)

Answer 94

Elkin et al found that CBT appears to be less suitable for people who have high levels of irrational beliefs that are both resistant and rigid to change.

Simons et al found that CBT also appears to be less suitable in situations where high levels of stress in the individual reflect realistic stressors in a person’s life that therapy cannot resolve.

Question 95

Alternative Treatments (2)

Answer 95

The most popular treatment for depression is the use of antidepressants such as SSRIs.

Drug therapies have the advantage of requiring less effort on patients. In addition to this, they are more cost effective than other therapy.

However, in the long term CBT may be more cost-effective can be seen as more appropriate than drug therapies as it’s designed to have long term benefits as it tries to alter the negative thoughts and beliefs at the root of depression; unlike drug therapies that when stopped can lead to patient’s relapse and thus their dependence on drug therapies.

Question 96

CBT may not work for the most severe cases (1)

Answer 96

In some cases depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT. They may not even be able to pay attention to what is happening in a session.

Although it is possible to work around this by using medication and while research has shown that one of the most effective method of treating depression is through the combination of SSRIs and CBTs, this is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression.

Question 97

Success may be due to the therapist–patient relationship (2)

Answer 97

Rosenzweig (1936) suggested that the differences between different
methods of psychotherapy, such as between CBT and systematic
desensitisation, might actually be quite small.

All psychotherapies share one essential ingredient – the therapist–patient relationship. It may be the quality of this relationship that determines success rather than any particular technique that is used.

A comparative review from Luborsky et al found very small
differences, which supports the view that simply having an opportunity to talk to someone who will listen could be what matters most.

Question 98

Overemphasis on cognition (2)

Answer 98

One weakness of CBT as a treatment for depression is that it may overemphasise the importance of cognition.

For example, McCusker (2014) stated that there is a risk that because of its emphasis on what is happening in the mind of the individual patient, CBT may end up minimising the importance of the circumstances in which the patient is living.

This is an issue because a patient living in poverty or suffering abuse needs to change their circumstances, and any approach to therapy that emphasises what is happening in the patient’s mind rather than their environment can prevent this. CBT used inappropriately can demotivate people to change their situation.

As a result, this casts into doubt the appropriateness and effectiveness of using CBT as a form of treatment for depression.

Question 99

Research support for effectiveness (1)

Answer 99

March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in adolescents with a main diagnosis of depression. After 36 weeks, CBT was shown to work as effectively as drug therapy (81% improvement) and paired together the rates of improvement were 86%.

This is a strength because it shows CBT is just as effective as drug therapy, and suggests a good case for making CBT the first choice of treatment in health care systems such as the NHS. It is a safer (less likelihood of addiction), more long-lasting alternative to drugs which may be beneficial for the majority of sufferers

As a result, this suggests that CBT is an effective way to treat depression.