Psychopathology - Paper 1 Flashcards

Paper 1

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1
Q

What is OCD?

A

an anxiety disorder which consists of obsessions and compulsions

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2
Q

What are the behavioural characteristics of OCD?

A

Compulsive behaviours and avoidance

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3
Q

What are compulsive behaviours? (OCD)

A

Where a person is compelled to repeat certain behaviours to reduce anxiety e.g., hand-washing, counting or tidying

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4
Q

What is avoidance? (OCD)

A

A person may avoid situations which trigger anxiety. Aim to reduce anxiety through this avoidance although this may interfere with normal day to day life

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5
Q

What are the emotional characteristics of OCD?

A

Anxiety and distress, shame/disgust

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6
Q

What is anxiety and distress in OCD?

A

Obsessions and compulsions are a source of considerable anxiety and stress. Feelings of anxiety are reduced by carrying out compulsive behaviours

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7
Q

What is shame/disgust in OCD?

A

Sufferers aware that their behaviour is excessive which causes feelings of embarrassment and shame

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8
Q

What are the cognitive characteristics of OCD?

A

Obsessions and awareness of excessive anxiety

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9
Q

What are obsessions in OCD?

A

The major cognitive symptom for 90% of OCD sufferers. Obsessions are persistent, recurring internal thoughts that may drive anxious feelings. These could be ideas, doubts, impulses or images which are often seen as uncontrollable and create anxiety

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10
Q

What is awareness of excessive anxiety in OCD?

A

The individual is aware that their obsessions and compulsions are irrational

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11
Q

What is the biological approach to explaining OCD?

A

Genetic explanations and neural explanations

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12
Q

What are the genetic explanations of OCD?

A

SERT and COMT gene

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13
Q

How does genetics explain OCD?

A

Genes we inherit can predispose us to OCD. Lewis found that 37% of his OCD patients had parents with it suggesting that specific genes are related to the cause of OCD. Two of these genes are COMT and SERT genes

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14
Q

What is the SERT gene in OCD?

A

When levels of serotonin are low, a person is more likely to get OCD. The SERT gene is involved in the transportation of serotonin, an inhibitory neurotransmitter. In people with OCD, the SERT gene mutates, causing lower levels of serotonin

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15
Q

What is the COMT gene in OCD?

A

COMT is an enzyme that regulates dopamine however in people with OCD, this gene mutates, preventing the COMT enzyme from regulating dopamine levels. This causes high levels of dopamine seen in many patients with OCD

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16
Q

How many genes are involved in OCD?

A

Taylor found that up to 230 different genes may be involved. There is also evidence to suggest that different types of OCD may be due to different gene combinations. OCD is polygenic.

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17
Q

What are the neural explanations of OCD?

A

Abnormal neurotransmitter levels and abnormal brain structure

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18
Q

What are abnormal neurotransmitter levels in OCD?

A

SEROTONIN helps to regulate mood causing LOW levels to be linked to depression and anxiety disorders such as OCD. Evidence for this that drugs which increase serotonin are effective in treating OCD. DOPAMINE has also been implicated in OCD having HIGH levels associated with compulsive behaviours

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19
Q

What are abnormal brain structures in OCD?

A

The Worry Circuit: The orbital prefrontal cortex is a region in the brain which converts sensory information into thoughts and actions

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20
Q

What is the process of the Worry Circuit (abnormal brain structure) in OCD?

A
  1. The OFC sends signals about potential hazards to the thalamus
  2. If these worry signals are not serious, they will be suppressed by the caudate nucleus, preventing them from reaching the thalamus
  3. When the caudate nucleus is damaged it fails to suppress minor or unimportant worry signals
  4. This causes the unnecessary thoughts and impulses to alert the thalamus
  5. These signals are then sent back to the OFC, reinforcing that belief that these unnecessary thoughts are impulses are a major concern that need an immediate and powerful response
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21
Q

What are the positive evaluation points of biological explanations of OCD?

A
  • Nestdat et al carried out an a meta-analysis of twin studies and found MZ twins had a concordance rate of 68% compared to 31% for DZ. They found that people with a first-degree relative with OCD were 5X more likely to develop it compared to general population. This increases the validity of the biological explanation and the link between genetics and OCD.
  • Antidepressants typically work by increasing levels of serotonin. These are effective in reducing the symptoms of OCD providing support for neural explanations. Soomro et al found that SSRIs were significantly more effective than placebos in treating OCD.
  • Menzies conducted MRI scans on OCD patients and their immediate family members without OCD (had a healthy control group). He found that OCD patients and their immediate family had reduced grey matter in OFC. This supports the view that differences in this brain region are inherited and may be contributing to the disorder
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22
Q

What are the negative evaluation points of biological explanations of OCD?

A

Criticisms of Menzies - researchers have been unable to identify which genes are causing the reduction in grey matter. This means that a genetic explanation is unlikely to be very useful because it provides little predictive value. It is unable to predict which relatives with the reduction in grey matter will develop OCD.

  • Diathesis stress model: may be better at explaining OCD. It acknowledges genetic vulnerability and the environment. It suggests that individual genes could cause a vulnerability of OCD but whether it develops depends on environment. Cromer et al found that over half their OCD patients had experienced a traumatic life event and OCD was more severe in patients who experienced more than one traumatic event. This shows that genes alone can’t be predictive of who will develop OCD.
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23
Q

What are the biological approaches to treating OCD?

A

Antidepressants and anti-anxiety drugs

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24
Q

What are antidepressants in treating OCD?

A

SSRIs are the standard medical treatment. used to tackle the symptoms of OCD involves an antidepressant called a selective serotonin reuptake inhibitor SSRI for short. Low levels of the serotonin are associated with depression as well as OCD, so drugs that increase levels of serotonin are used with both mental disorders

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25
Q

How do SSRIs work in OCD?

A
  1. Serotonin is released into the synapse by the presynaptic neuron
  2. After serotonin has crossed the synapse from the presynaptic neuron, it is reabsorbed by the presynaptic neuron (reuptake mechanism) ready to be reused
  3. SSRIs work by inhibiting this reabsorption. This results in more serotonin staying in the synapse for longer. This allows the serotonin to stimulate the postsynaptic neuron for longer, compensating for the deficiency in the serotonin system. SSRIs help to reduce the anxiety associated with OCD and normalise the worry circuit
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26
Q

What is the typical dose for an SSRI for OCD?

A

Fluoxetine - 20mg. It takes 3-4 months of daily use for SSRIs to have much impact on symptoms

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27
Q

What are anti-anxiety drugs for treating OCD?

A

Benzodiazepines are commonly used to reduce anxiety. They work be increasing the activity of the neurotransmitter GABA. This has a quieting effect on neurons in the brain helping to slow down brain activity

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28
Q

How does GABA work? (OCD)

A
  1. GABA is released into the synapse by the presynaptic neuron
  2. It locks onto receptors on the postsynaptic neuron
  3. This opens a channel that increases the flow of chloride ions into the neuron
  4. Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, thus slowing down its activity, reducing the anxiety experienced due to obsessions and makes the person with OCD feel more relaxed
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29
Q

What are the definitions of abnormality?

A

Statistical infrequency, deviation from social norms, failure to function adequately and deviation from ideal mental health

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30
Q

What is statistical infrequency?

A

Occurs when an individual has a less common characteristic, for example being more depressed or less intelligent than most of the population

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31
Q

What is deviation from social norms?

A

Concerns behaviour that is different from the accepted standards of behaviour in a community or society

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32
Q

What is failure to function adequately?

A

Occurs when somebody is unable to cope with ordinary demands of day-to-day living

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33
Q

What is deviation from ideal mental health?

A

Occurs when somebody does not meet a set of criteria for good mental health

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34
Q

How can we explain deviation from social norms further?

A

Each society has norms. This definition classes any behaviour as abnormal if it goes against the accepted, expected and approved ways of behaving in a society. This definition suggests abnormality can be seen as breaking the rules of society.
E.g., society doesn’t see it to be acceptable behaviour to hear voices or see things that are not there (hallucinations) - SZ

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35
Q

What are the negative evaluation points of deviation from social norms?

A
  • Social norms change as times change. What is socially acceptable now may not have been 50 years ago. E.g., homosexuality is acceptable but in the past it was included under ‘sexual and gender identity disorders’ in the DSM. This lack of consistency reduces the reliability of the definition
  • Has been criticised because social norms differ between cultures. Norms are culturally relative. E.g., hearing voices is viewed as a deviation from social norms in our cultures but in others, it is more accepted and not viewed as deviant. This is a problem, a reliable definition should be consistent between cultures
  • Using social norms to define abnormality can be seen as punishing people who are trying to express their individuality and repressing people who don’t conform to the repressive norms of their culture. E.g., World Health Organisation declassified homosexuality as a mental illness in 1992 and transgender health issues in 2019. These recent changes may have followed social norms/acceptance. Limitation because it can be damaging to certain people in society so another definition may be appropriate
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36
Q

What are the positive evaluation points of deviation from social norms?

A

+ It is a more appropriate definition especially when compared to statistical infrequency. This is because it distinguishes between desirable and undesirable behaviour and the effect the behaviour has on others. E.g., spending a lot of time washing your hands may not be statistically infrequent, but it can have a damaging effect on the person and their loved ones.

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37
Q

How can we explain failure to function adequately further?

A

This means that a person is unable to cope with everyday life or engage in everyday behaviours. Not functioning adequately causes distress and suffering for the individual and/or cause distress for others.

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38
Q

What did Rosenhan and Seligman say that characteristics of features of abnormality are?

A
  1. Suffering
  2. Maladaptive behaviour - behaviour where a person is stopping themselves from progressing
  3. Unconventionality - behaviour needs to be odd
  4. Unpredictability and loss of control - most people tend to behave in a fairly predictable way on the other hand an abnormal person is expected to act in an inappropriate manner
  5. Irrational and incomprehensibility - refers to instances where someone may act in a certain way which people can’t understand

E.g., someone with SZ - it would be irrational to have delusions of grandeur such as believing you are the Queen

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39
Q

What are the positive evaluation points of failure to function adequately?

A
  • It includes the patient’s perspective. This allows us to view the mental disorder from the point of view of the person who experiences it. E.g., the level of distress experienced by the patient is considered when defining their behaviour as abnormal. This suggests FFA is a useful criterion for assessing abnormality as it provides a checklist which patients can use to help them perceive their level of functioning
  • Abnormality is not always accompanied by dysfunction. Psychopaths can cause great harm yet still appear normal. E.g., Harold Shipman was abnormal but didn’t display features of dysfunction therefore the definition may not be appropriate
  • Definition is limited by cultural relativism. Long periods of grief after bereavement is more acceptable in some cultures than others. This means that the same behaviour could be defined as abnormal because it is viewed as a failure to function in one culture but not another, the definition is not reliable
  • Abnormality could be due to other factors. E.g., someone who is unable to hold down a job may be in this situation due to the economic situation of their country, not mental health. This means that by using this definition, people would incorrectly be labelled as abnormal when other definitions may not label them as abnormal. Suggests that it is not appropriate in all cases and another definition may be more valid
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40
Q

How can we explain statistical infrequency further?

A

Any behaviour that is statistically rare would be classed as abnormal. Deciding what is statistically rare requires us to examine a normal distribution curve in order to identify what proportion of people share the characteristics or behaviour being looked at. A person is abnormal because their behaviour is infrequent i.e. two standard deviations from the mean.
E.g., only 1% suffer with SZ so it is considered statistically rare because it is more than two standard deviations away from the mean

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41
Q

What is a positive evaluation point of statistical infrequency?

A

It is an objective way to define abnormality, as a ‘clear cut off’ point has been agreed. This makes it easier to divide who meets the criteria to be labelled as abnormal in comparison to other definitions. Therefore this definition is seen as less subjective than the other definitions

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42
Q

What are the negative evaluation points against statistical infrequency?

A
  • There are many abnormal behaviours which are desirable e.g., high IQ. There are some normal behaviours which are undesirable e.g., depression is common. This is a problem when planning treatment as only undesirable behaviours need to be identified. Therefore, the definition would never be used alone to make a diagnosis
  • We need to decide where to separate normality from abnormality. Many disorders like depression vary greatly between individuals in terms of severity. This makes it difficult to decide where the cut-off point lies e.g., at what point does crying (a common symptom of depression) become abnormal? This is a problem as the cut-off point is subjectively determined, lacking the validity needed to be an effective explanation
  • The definition may be culturally biased. This is because there are some behaviours that are statistically infrequent in some cultures but are more frequent than others. E.g., one symptom of SZ is claiming to hear voices, however this is an experience that is common in some cultures. This is problematic as statistical infrequency would class these individuals as abnormal even when they were displaying normal behaviour, so the definition can only be used to define abnormality in some cultures
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43
Q

How can we explain deviation from ideal mental health further?

A

It attempts to define the criteria required for ideal mental health, people who lack these are abnormal. Jahoda defined ideal mental health through 6 characteristics which argue that a psychologically healthy individual with ideal mental health should be able to show

E.g., SZ would be seen as abnormal as seeing or hearing things that are not there is not an accurate perception of reality

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44
Q

What are Jahoda’s 6 characteristics for optimal living?

A

-Perception of reality - they should be able to see the world as it it
-Resistance to stress - being able to cope with stressful situations
-Self-attitudes - high self-esteem and a strong sense of self-identity
-Autonomy - they should function as independent individuals
-Self-actualisation and personal growth - being focused on the future and on fulfilling their potential
-Mastery of the environment - the ability to adjust to new situations; functioning at work and in relationships with others

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45
Q

What are the positive evaluation points of deviation from ideal mental health?

A

It offers an alternative perspective on mental disorders. This is because the definition focuses on the positive desirable behaviours rather than the negative undesirable behaviours. Her ideas are in accord with the humanistic approach which also focuses on the positive aspects of human nature

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46
Q

What are the negative evaluation points of deviation from ideal mental health?

A
  • The definition may be culturally biased (ethnocentric) this is because the ideals of mental health are not applicable to all cultures. E.g., the criterion of self-actualisation is relevant to members of individualistic cultures but not collectivist’ cultures, where individuals strive for the greater good of the community rather than for self-centred goals. This is a problem because for the definition to be classed as reliable, the same behaviour should be viewed consistently between cultures
  • It is unclear how many criteria need to be lacking before we are seen to be ‘deviating from ideal mental health’ E.g., do all 6 criterion need to be present etc a subjective judgement must be made. It is left to individual psychiatrists to judge whether someone is deviating enough to be diagnosed and this could lead to inconsistency. This lack of objectivity means that this definition of abnormality is rarely used in the real world
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47
Q

What are behavioural characteristics?

A

Ways in which people act

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48
Q

What are phobias?

A

An irrational fear of an object or situation

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49
Q

What are emotional characteristics?

A

Ways in which people feel

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50
Q

What are cognitive characteristics?

A

Ways in which people process information, including perception, attention and thinking

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51
Q

What is the DSM?

A

A classification and diagnosing system which is published by the American Psychiatric Association. It is updated every so often as ideas about abnormality change

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52
Q

How does the DSM-5 categorise phobias?

A

Phobias are a type of anxiety disorder, all are characterised by excessive fear and anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus. It recognises specific, social and agoraphobia as categories of phobias

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53
Q

What are specific phobias?

A

Also known as a simple phobia, this is fear of an object, such as an animal, or a situation such as flying or having an injection

54
Q

What are social phobias?

A

Phobia of a social situation such as public speaking or using a public toilet

55
Q

What is agoraphobia?

A

Fear of leaving home or a safe place. Can be characterised by fear of being outside or in a public place

56
Q

What are the behavioural characteristics of phobias?

A

Panic, avoidance and disruption of functioning

57
Q

What is panic in phobias? (Behavioural characteristics)

A

Most phobic people panic in response to the presence of a phobic stimuli. Panic can be in the form of behaviours such as crying, screaming, running away or freezing

58
Q

What is avoidance in phobias? (Behavioural characteristics)

A

As anxiety increases by being close to the feared situation, it is natural to avoid certain situations where the object will be. For example, if someone has a fear of ghosts they do not take a short-cut home. through a graveyard at midnight

59
Q

What is disruption of functioning in phobias? (Behavioural characteristics)

A

Anxiety and avoidance responses are so extreme that they severely interfere with the ability to conduct everyday working and social functioning. For example, a person with a social phobia will find it very hard to socialise with others, or indeed interact meaningfully with them at work

60
Q

What are the emotional characteristics of phobias?

A

Anxiety and fear

61
Q

What is anxiety in phobias? (Emotional characteristics)

A

An unpleasant state of high arousal which makes it very difficult to experience any positive emotions. The anxiety experienced can be long term. It is due to the presence of or anticipation of feared objects and situations

62
Q

What is fear in phobias? (Emotional characteristics)

A

The emotional responses of fear which accompanies many phobic stimuli is often extremely unreasonable. For example, an individual’s fear of spiders will involve a very strong emotional response to a tiny, harmless spider. This fear is DISPROPORTIONATE to the actual danger posed by the spider

63
Q

What are the cognitive characteristics of phobias?

A

Irrational beliefs and selective attention

64
Q

What are irrational beliefs in phobias? (Cognitive characteristics)

A

Sufferers often hold irrational beliefs in relation to the phobic stimuli. They are also very resistant to rational arguments, for example, a person with a fear of flying is not helped by arguments that flying is actually the safest form of transport

65
Q

What is selective attention in phobias? (Cognitive characteristics)

A

Sufferers will often look intently at a phobic stimulus and find it very difficult to look away from them. It is usually useful to keep our attention on something dangerous so we can react to the threat quickly. However, it is not useful when the fear is irrational as this can interfere with day to day life. For example, a pogonophobic will struggle to concentrate on what they’re doing if someone in the room has a beard

66
Q

What is classical conditioning?

A

Learning by association. Occurs when two stimuli are repeatedly paired together - UCS and NS. The NS eventually produces the same response that was first produced by the UCS alone, becoming the CS

67
Q

What is operant conditioning?

A

A form of learning in which behaviour is shaped and maintained by its consequences. Possible consequences of behaviour include positive reinforcement, negative reinforcement and punishment

68
Q

What is the behavioural approach to explaining phobias?

A
  • Two process model
    Behaviourists argue that like any behaviour, phobias are learned through the environment
69
Q

What does the two process model say?

A

Phobias are acquired by classical conditioning and maintained through operant conditioning

70
Q

How does classical conditioning result in people acquiring phobias?

A

A phobia is acquired through the association of a stimulus with a response. E.g., Watson and Rayner induced a fear of white rats in Little Albert by pairing the rat (NS) and a loud noise (UCS). The resulted in a new stimulus (CS) being learnt

71
Q

How can you explain fear of dogs through the behavioural approach?

A
  • Being bitten (UCS) creates fear (UCR)
  • Dog (NS) associated with being bitten (UCS)
  • Dog (now CS) produces fear response (now CR)
72
Q

How does operant conditioning result in people maintaining phobias?

A

With negative reinforcement, an individual avoids a situation that is unpleasant e.g., a person with a fear of dogs will avoid visiting friends with dogs. A person with a fear of enclosed spaces (claustrophobia) will avoid going into a life.
Avoiding the phobic stimulus allows them to escape the fear and anxiety that they would have suffered if they had remained. This reduction in fear reinforces the avoidance behaviour and maintains the phobia

73
Q

What are the positive evaluation points of the two process model?

A

+ It can be tested in an objective and rigorous way. Mowrer tested his two-process model by pairing a buzzer sound with an electric shock. Through negative reinforcement, Mowrer trained rats to escape a shock by jumping over a barrier when the buzzer sounded. This demonstrates avoidance behaviour and increases the scientific validity of the behaviourist explanations of phobias

+ Has practical applications because there are several behavioural therapies which use conditioning to treat phobias. e.g., systematic desensitisation has been shown to be an extremely successful therapy for a range of different phobias. Evidence to support this comes from McGrath et al who found that 75% of phobic patients showed an improvement in their symptoms after treatment strengthening the validity

74
Q

What are the negative evaluation points of the two process model?

A
  • Argued the behaviourist explanation is incomplete as it fails to explain the role evolution plays. Seligman found in his research that we are innately predisposed to fear things such as snakes, as these things have been a source of danger in our evolutionary past.This helps to explain who people may fear things they have never encountered. Therefore the model may be too simplistic saying there is more to acquiring phobias than conditioning
  • It fails to explain the cognitive aspects of a phobia. A person in a lift may think ‘I could become trapped in here and suffocate’. This irrational thought creates extreme anxiety and may trigger a phobia. This is a weakness as the behavioural explanation is failing to explain a vital component of the disorder.
    Therefore: an approach that incorporates both behavioural and cognitive components is required in order to provide a through explanation of the disorder
75
Q

What are the behavioural ways of treating phobias?

A

Systematic desensitisation and flooding

76
Q

What is systematic desensitisation?

A

A behavioural therapy designed to gradually reduce phobic anxiety through the principles of classical conditioning. If the sufferer can learn to relax in the presence of the phobic stimulus, they’ll be cured. A new response to the phobic stimulus is learned. This learning of a different response is called counterconditioning
There are three processes involved in SD

77
Q

What are the 3 processes involved in systematic desensitisation?

A

Anxiety hierarchy, relaxation and exposure

78
Q

What is the anxiety hierarchy?

A

A phobic patient works with a therapist to develop an ‘anxiety hierarchy’. This is a list of situations related to the phobic stimulus, starting with the least fearful situation at the bottom (e.g., fear of dogs start by looking at a picture of a dog and ending with stroking one

79
Q

What is relaxation in systematic desensitisation?

A

It is impossible to be afraid and relaxed at the same time, as one emotion prevents the other. This is called reciprocal inhibition. Therefore, teaching relaxation techniques is a vital apart of SD. Typical relaxation techniques that are taught include deep breathing, mindfulness and visualisations. Alternatively, relaxation is sometimes achieved using anti-anxiety drugs such as valium

80
Q

What is exposure in systematic desensitisation?

A

The patient is exposed to a phobic stimulus whilst in a relaxed state. The patient starts at the bottom of the fear hierarchy and when they can remain relaxed at that level, they progress onto the next level. Over several sessions, the patient gradually moves their way up the hierarchy, SD is successful when the patient can maintain relaxation in the most feared/highest level on the hierarchy

81
Q

How can exposure in systematic desensitisation be done?

A

In vitro - the client imagines exposure to the phobic stimulus
In vivo - the client is actually exposed to the phobic stimulus

82
Q

What are the positive evaluation points of systematic desensitisation?

A

+ Proven to be effective at treating phobias. McGrath et al reported that 75% of patients showed an improvement in their symptoms after SD. Gilroy followed up 42 patients after they had been treated for a spider phobia. 33 months later, they showed less fear than a control group. This evidence is a strength because it shows that SD can be used to treat the majority of sufferers and effects are long lasting

+ Sufferers tend to prefer it to the alternative therapy of flooding. This is largely because it doesn’t cause the same degree of trauma as flooding. This is supported by the fact that SD has low attrition rates (low dropout). This matters because SD is able to help a higher number of patients than flooding

83
Q

What are the negative evaluation points of systematic desensitisation?

A
  • Not an effective treatment for all phobias. Ohman suggest that SD may not be as effective in treating phobias that have an underlying evolutionary component e.g., fear of heights or dangerous animals. This reduces the usefulness of this treatment. It is only really suitable for patients who are able to effectively use the relaxation techniques and who have imaginations that are viivd enough to think up images of fear objects/events
84
Q

What are the economic strengths of systematic desensitisation?

A

It is very cost effective for most phobias and is therefore cheap to deliver to sufferers, compared to other therapies. It is estimated that mental health issues cost the English economy around £22.5 billion a year. This figure does not include indirect costs such as loss of employment. This is positive because it means cost effective therapies for phobias not only have a positive impact on sufferer’s lives, but also have economic benefits too

85
Q

What is flooding?

A

involves exposing phobic patients to their phobic stimulus but without gradual progression seen in SD. Clients are immediately exposed to a very frightening situation. It is usually one long session in which the patient experiences the phobia at its worst whilst at the same time practising relaxation. The session continues until the patient is fully relaxed.
Flooding stops phobic responses very quickly. This may be because the patient cannot avoid the stimulus. Therefore they quickly learn that the phobic stimulus is harmless. In classical conditioning this process is called extinction. A learned response (CR) is extinguished when a CS is encountered without the UCS resulting int he CS no longer producing the CR

86
Q

What are the positive evaluation points of flooding?

A

It is a cost effective treatment for phobias. Research has shown that flooding is just as effective at treating phobias as SD, however it is significantly quicker. This means patients are free of their symptoms as soon as possible, making treatment cheaper

87
Q

What are the negative evaluation points of flooding?

A
  • It is highly traumatic for patients. The problem isn’t that it is unethical as patients have given consent but patients are often unwilling to see it through to the end. This means time and money are wasted preparing patients only to have them refuse to start or complete treatment
  • Less effective for social phobias and agoraphobia. This is because behavioural treatments are unable to treat the irrational thinking (cognitive) that is more common with complex phobias.This suggests that other treatment such as CBT may be more effective at treating those phobias. Shows flooding is a restricted phobia
88
Q

What is depression?

A

A mood disorder which is characterised by low mood and low energy levels. A major depressive disorder is severe by short term and a persistent depressive disorder is longer term and/or recurring

89
Q

What are the behavioural characteristics of depression?

A

Disruption of sleep and eating, loss of energy

90
Q

What is disruption of sleeping and eating in depression?

A

Depression is associated with disruption in our normal eating and sleeping behaviours, insomnia and hypersomnia are common and appetite can also increase or decrease with depression which can lead to weight loss or gain

91
Q

What is loss of energy in depression?

A

Some depressed people have reduced energy resulting in fatigue, lethargy and high levels of inactivity e.g., they may struggle to get out of bed and do usual daily activities

92
Q

What are the emotional characteristics of depression?

A

Sadness and anger

93
Q

What is sadness in depression?

A

The most common description people give of their depressed state, along with feeling empty. Associated with this, people may feel worthless, hopeless and/or experience low self-esteem

94
Q

What is anger in depression?

A

Negative emotions can, also be shown in the form of anger. This anger can be directed as aggression towards oneself e.g., self harming or towards others

95
Q

What are the cognitive characteristics of depression?

A

Focussing and dwelling on the negative, poor concentration

96
Q

What is focusing and dwelling on the negative in depression?

A

People with depression often view themselves, the world and the future in negative wats. They may have a bias towards reporting unhappy events in their lives rather than happy events. Such negative thoughts are irrational i.e they do not accurately reflect reality

97
Q

What is poor concentration in depression?

A

Sufferers often find themselves unable to stick to a task or make decisions. This is then likely to interfere with a sufferer’s work and ability to communicate

98
Q

What are the cognitive approach’s explanations of depression?

A

Ellis’ ABC model and Beck’s Negative Triad

99
Q

What does the cognitive approach say about depression?

A

It is not the events in people’s lives that cause depression, it is the way they think about these events. There are two main examples of the cognitive approach to explaining depression

100
Q

What is Ellis’ ABC model?

A

There is an activating event which leads to beliefs and then consequences

101
Q

What is utopianism?

A

Belief that life should always be fair

102
Q

What is musturbation?

A

Must succeed

103
Q

What is the activating event in Ellis’ ABC model?

A

E.g., getting sacked at work. Events like failing an important test or ending a relationship might trigger rational beliefs

104
Q

What is the Belief part of Ellis’ ABC model?

A

May be rational or irrational. E.g., the company was overstaffed or I was sacked because they’ve always had it in for me. According to Ellis, the source of irrational beliefs lies in mustabatory thinking. This is the belief that we must always succeed or achieve perfection e..g, I MUST be liked by everyone, I MUST get an A on all my tests

105
Q

What are the Consequences part of Ellis’ ABC model?

A

Rational beliefs lead to healthy emotions e.g., acceptance whereas irrational beliefs lead to unhealthy emotions, including depression

106
Q

Give a brief overview of Beck’s negative triad

A

He believed that depressed individuals feel as they do because their thinking is biased towards negative interpretations of the world. It is also based on negative self-schemas

107
Q

What are negative self-schemas?

A

Depressed people acquire a negative schema about themselves (self-schema) during childhood. These schemas are often caused by parental and/or peer rejection and criticism. They can lead to cognitive biases (distortions) in thinking

108
Q

What are the cognitive biases?

A

Selective abstraction - drawing conclusions on the basis of just one of many elements of a situation

Minimisation - downplaying the importance of positive thought, emotion or event

Personalisation - attributing personal responsibility for events which aren’t under a person’s control

Arbitrary inference - drawing conclusions when there is little or no evidence

Magnification - blowing things out of proportion

Overgeneralisation - making sweeping conclusions based on a single event

109
Q

What is the negative triad?

A

Negative schemas and cognitive biases maintain the negative triad. It is a pessimistic and irrational view, caused by 3 types of negative thinking that occur automatically, regardless of the reality of what is happening at the time. What are the 3 negative views? He argues this triad creates a cognitive vulnerability that can lead to depression

110
Q

What are the 3 negative views in the negative triad?

A

The self - “I am a bore”. Such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem

The world - “Everything is against me, everyone leaves me”. This creates the impression that there is no hope anywhere

The future - “I will always be on my own”. Such thoughts reduce any hopefulness and enhance depression

111
Q

What are the positive evaluation points of Beck’s theory?

A

There is supportive evidence that depression is due to negative thinking. Grazioli and Terry assessed 65 pregnant women before and after birth. They found that those who had a high number of cognitive biases were more likely to suffer post-natal depression. These cognitive biases were present BEFORE the depression developed. Clark and Beck carried out a meta-analysis of research into this area and found strong support for Beck’s cognitive theory. This evidence suggests that it is a valid explanation of depression

112
Q

What are the negative evaluation points of Ellis’ theroy?

A

The ABC model cannot explain all types of depression because not all cases of depression are triggered by an activating event. Endogenous depression is caused by chemical and/or genetic factors, rather than an activating life event. This means that the explanation only applies to some kinds of depression so is an invalid explanation

113
Q

What are the general positive evaluation points of Beck and Ellis’ theory?

A

A strength of the cognitive explanation is that it has been applied to CBT which has been consistently found to be the best treatment for depression. The success of the treatment lends support to the cognitive explanation. If depression is alleviated by challenging irrational thinking then this suggests such thoughts had a role int he depression in the first place increasing the validity

114
Q

What are the general negative evaluation points of Beck and Ellis’ theory?

A
  • The cognitive approach appears to blame patients for their depression suggesting its a result of the way a person thinkings and recovery is only possible by changing thought processes. This places a large burden of blame on a person already prone to negative thinking. In some cases, changing the situation may be more important than focussing on cognitive factors
  • The biological approach provides an alternative explanation for depression. It argues that depression is caused by low levels of serotonin. The success of anti-depressants which increase serotonin supports the view that biological factors play a part. The diathesis stress approach may be a better explanation because it suggests individuals with a genetic vulnerability for depression are more prone to stressful life events leading to negative thinking
115
Q

What is CBT?

A

The aim of CBT is to replace irrational, negative thoughts experienced by depressed patients with more rational, positive ones, leading to more constructive emotional and behavioural responses

116
Q

How is CBT carried out?

A

Starts with an initial assessment in which the patient and therapist identify the depressive symptoms and agree on a set of goals. In order to help the client achieve their goals and change their negative thinking, most CBT therapists use techniques taken from both forms of CBT - Beck’s cognitive therapy and Ellis’s rational emotive behaviour therapy

117
Q

What is Beck’s cognitive therapy?

A

Identifies negative thoughts the client has about the world, the self and future (negative triad). Once identified, these thoughts must be challenged.
Patients are often set homework such as to record when they enjoyed an event. It can be used to encourage depressed clients to become more active and to engage in pleasurable activities.
Cognitive therapy also aims to help patients test the realyi of their negative beliefs. This is referred to as the ‘patient as the scientist’, investigating the reality of their negative beliefs in the way a scientist would

118
Q

What is Ellis’s Rational Emotive Behaviour Therapy (REBT)?

A

REBT extends the ABC model to ABCDE. D stands for disputing irrational beliefs and replacing them with effective rational ones and E for the effects of disputing the beliefs leading to constructive behaviours (don’t describe ABC model)
There are 3 types of disputing

119
Q

What is the process of Ellis’s REBT?

A

Activating event –> Beliefs about event –> Consequences (emotional) –> Disputations to challenge irrational beliefs –> Effective new beliefs replace the irrational ones

120
Q

What are the 3 types of disputing in the REBT model?

A

Logical, empirical and pragmatic

121
Q

What is logical disputing?

A

Self-defeating beliefs do not follow logically from the information available (e.g., “Does thinking in this way make sense?”)

122
Q

What is empirical disputing?

A

Self-defeating beliefs may not be consistent with reality (e.g., “Where is the proof that this belief is accurate?”)

123
Q

What is pragmatic disputing?

A

Emphasises the lack of usefulness of the beliefs (e.g., “How is this belief likely to help me?”)

124
Q

What are the positive evaluation points of cognitive treatment (CBT) as a treatment for depression?

A

+ CBT is proven to effective. March et al compared CBT with drug therapy. After 36 weeks they found that 81% of patients showed improvement in both groups. This is a strength because it shows that CBT is just as effective as drug therapy at treating depression but without the unpleasant side effects
COUNTERARGUMENT:
CBT is not the preferred method of treatment for most patients. Drug therapy requires little effort and is just as effective. It is also less expensive and doesn’t require trained therapists so drug therapy may be more beneficial to the economy than CBT

+ CBT has economic benefits. It is estimated mental health issues cost the english economy around £22.5 billion per year. It is proven to be effective treatment reducing unnecessary healthcare costs on treatments that are ineffective and enables people to return to work, helping the economy

125
Q

What are the negative evaluation points of cognitive treatment (CBT) as a treatment for depression?

A

CBT may not work for all sufferers because it requires patients to commit to attending regular sessions with a therapist, completing homework and putting into practice techniques learnt. This is more disruptive to patient’s’ lives than just taking medication. Patients may lack the motivation to engage successfully in these programmes. Not suitable for all sufferers

126
Q

What are other anti-anxiety drugs used to treat OCD?

A

SNRIs and Tricyclics

127
Q

What are SNRIs?

A

These drugs work by preventing the reuptake mechanism of serotonin and noradrenaline, thus increasing the levels of both of these neurotransmitters and reducing anxiety

128
Q

What are Tricyclics?

A

An older drug which work in the same manner as SNRIs, but have more severe side effects

129
Q

What are the positive evaluation points of anti-anxiety drugs for OCD?

A

+ There is clear evidence for the effectiveness of drug therapy in reducing symptoms of OCD. Soomro et al reviewed studies comparing SSRIs to placebos in the treatment of OCD. They found that SSRIs were significantly more effective than placebos in treating OCD. Kahn et al compared placebos and Benzodiazepine in 250 patients. They found that BZs were significantly superior to placebos showing that drug therapy improves quality of their lives

+ There are cost-effective and don’t require a trained therapist and are less disruptive to the patient’s lives. Allow patients to reduce their symptoms without having to engage with much of the hard work like CNT. They enable people to control their symptoms with minimal effort, saving time and money. Drug therapies also combine well with CBT

130
Q

What are the negative evaluation points of anti-anxiety drugs for OCD?

A
  • Drug therapies are more commonly used to treat OCD, in a comprehensive review of treatments for the disorder. Koran argued that CBT should be tried first. This is because drugs only treat the symptoms rather than the root cause. It is effective in the short-term by placing a ‘chemical mask’ and are not a lasting cure. Patients normally relapse within a few weeks after medication is stopped. CBT or combined may be more suitable
  • Common side effects of SSRIs include blurred vision, indigestion and loss of sex drive. These may not seem that terrible but are enough to make a patient prefer not to take the drug. Some patients also experience more serious side effects like hallucinations, erecting problems and raised blood pressure. BZs are highly addictive and can result in increased aggression and LTM impairments so are only prescribed for short-term. Side effects diminish the effectiveness of drug treatments, as patients will often stop taking medication if they experience these side effects