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Psychopathology part 2 Flashcards

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1
Q

What are the two ways to treat phobias (The Behavioural Approach to Treating Phobias)

A

Flooding and systematic desensitisation

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2
Q

Describe Flooding (The Behavioural Approach to Treating Phobias)

A
  • one long session this could last between 1-3 hours this is because a person adrenaline being released and therefore there fear response has a time limit
  • patient experiences fear at the same time as trying to relax - the session continues until the patient is fully relaxed
  • can be conducted in vivo (actual exposure) or virtual reality
    1. patient is taught relaxation techniques
    2. patient masters the feared situation that caused them to seek help in the first place
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3
Q

What is used in systematic desensitisation (The Behavioural Approach to Treating Phobias)

A
  • counterconditioning - this is when the patient is taught a new association that runs counter to the original association - relaxation instead of fear
  • relaxation - relaxation techniques are taught to the patient - focus on their breathing and take deep breaths and use progressive muscle relaxation
  • desensitisation hierarchy - gradually introduce the person to the feared situation - at each stage the patient has to fully relax before they can progress to the next stage.
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4
Q

Describe the steps used in systematic desensitisations (The Behavioural Approach to Treating Phobias)

A
  1. patient is taught how to relax their muscles completely as anxiety is not compatible with relaxation
  2. therapist and patient together construct a desensitisation hierarchy - each one causing more anxiety than the previous
  3. patient gradually works there way through the hierarchy completely relaxing in the previous stage before moving on to the next
  4. once patient has mastered one step they move on to the next
  5. patient eventually masters the feared situation
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5
Q

Evaluation of the behavioural approach to treating Phobias, Systematic Desensitisation: Effectiveness

A

-SD was found successful for a range of phobic disorders
- McGrath et al 1990 - reported that 75% of patients with phobias respond to SD
Choy et al 2007 - have to have actual exposure as it is more effective therefore in vivo more effective
- Comer 2002 - modelling is also effective

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6
Q

Evaluation of the behavioural approach to treating Phobias, Systematic Desensitisation: Not appropriate for all phobias

A

Ohman et al 1975 - SD may not be effective in treating phobias that have an underlying evolutionary survival component, then treating phobias which are personal

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7
Q

Evaluation of the behavioural approach to treating Phobias, Systematic Desensitisation: Strengths of behavioural therapies

A
  • generally fast
  • less effort on patients half
  • lack of thinking is also useful for patients who lack insight into their motivations or emotions and for people with learning difficulties
  • self-administered - cheaper
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8
Q

Evaluation of the behavioural approach to treating Phobias, flooding: Individual differences

A
  • not for every patient
  • highly traumatic
  • may quit during the process rendering useless
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9
Q

Evaluation of the behavioural approach to treating Phobias, Flooding: Effectiveness

A
  • those who stick with it, it is quick and effective
  • Choy et al - flooding was more effective
  • one the other hand Craske et al 2008 - both equally effective
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10
Q

Evaluation of the behavioural approach to treating Phobias: Relaxation may not be necessary

A
  • the success of both is due to the exposure than relaxation
  • klein et al 1983 - compared SD with supportive psychotherapy for patients with either social or specific phobias - found no difference in effectiveness
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11
Q

Evaluation of the behavioural approach to treating Phobias: Symptom Substitution

A
  • behavioural therapies may not work as symptoms are only the tip of the iceberg - if the symptoms are removed the cause still remains and the symptoms could still resurface
  • Freud 1909 - recorded the case of little hans - his fear was removed when he accepted his feelings about his father
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12
Q

What are the parts that make up Ellis’ ABC model, 1962? (The Cognitive Approach to explaining Depression)

A
  • A - refers to the activating event
  • B - the belief which may be rational or irrational
  • C - the consequence that the rational or irrational beliefs lead to - rational - happy, irrational - unhealthy emotions
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13
Q

Give an example of Ellis’ ABC model, 1962 (The Cognitive Approach to explaining Depression)

A
  • A - get fired
  • B - rational - I was sacked as it was overstaffed, irrational - I was sacked as they always had it in for me
  • C - rational - acceptance, irrational - depression
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14
Q

What is musturbatory thinking ELLIS (The Cognitive Approach to explaining Depression)

A
  • source of irrational thinking, it involves thinking that certain ideas must be true for an individual to be happy
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15
Q

What are the three most important irrational beliefs, ELLIS? (The Cognitive Approach to explaining Depression)

A
  • I must be approved of or accepted by people I find important
  • I must do well or I am worthless
  • The world must give me happiness or I will die
    other irrational symptoms include
  • others must treat me fairly and give me what I need
  • people must live to my expectations or its terrible
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16
Q

Describes Beck’s Negative Schema (The Cognitive Approach to explaining Depression)

A
  • depressed people usually develop a negative schema during childhood
  • they have a negative view of the world
  • caused by parental and peer rejection or criticisms by teachers
  • lead to systematic cognitive biases in thinking and are activated every time a new situation is encountered
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17
Q

Describe Beck’s Negative Triad (The Cognitive Approach to explaining Depression)

A
  • these are pessimistic and irrational view of the three key elements
  • Negative schemas and cognitive biases maintain a negative bias
  • The self
  • The world
  • The future
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18
Q

Give an example of Beck’s Negative Triad (The Cognitive Approach to explaining Depression)

A

The self - “ I am just plain undesirable and there is nothing to like about me”
The World - “ I can understand why people don’t like me, they would prefer other peoples company even my boyfriend left me”
The future - “I am always going to be on my own, there is nothing that is going to change this”

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19
Q

Evaluation of the Cognitive Approach to explaining Depression: Support for the role of irrational thinking

A

supported by research
- Hammen and Krantz 1976, found that depressed participants made more errors in logic when asked to interpret written materials than non-depressed participants
- Bates et al 1999 - found that depressed people who were given negative automatic-though statements become more and more depressed
on the other hand
- just because there is a link between negative thoughts and depression it does not mean that negative thoughts cause depression - an individual may adopt negative views due to their depression
- genetic predisposition may make them more susceptible to negative thoughts and depression

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20
Q

Evaluation of the Cognitive Approach to explaining Depression: Blames the client rather than situational factors

A
  • cognitive approach suggests that it is clients that are responsible for their disorder - good as the client can change that
  • however there are disadvantages for this - people may overlook situational effects - these could lead to depression
  • changing other aspects on the clients life may remove the depression
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21
Q

Evaluation of the Cognitive Approach to explaining Depression: Practical applications in therapy

A
  • helped developed CBT - cognitive behavioural therapy
  • consistently doung to be best treatment for depression especially used with drug treatments - Cuijpers et al 2013 supports this
  • if depression is relived by getting rid of negative thoughts then it proves that these caused and played a role in causing the depression in the first place
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22
Q

Evaluation of the Cognitive Approach to explaining Depression: irrational beliefs may be realistic

A
  • not all irrational beliefs are irrational - they may seem irrational
  • Alloy and Abrahmson in 1979 suggest that depressive realists tend to see things for what they are, gave a more accurate estimate of the likelihood of a disaster
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23
Q

Evaluation of the Cognitive Approach to explaining Depression: Alternative explanations

A
  • biological approach suggests that genes and neurotransmitters may cause depression
  • Zhang et al 2005 - found that the role of the neurotransmitter serotonin has low levels in depressed people, also found a gene that is 10x more common in depressed people
  • a diathesis-stress approach is advisable as individuals with a genetic vulnerability for depression are more prone to living in a negative environment
24
Q

What is the aim of Cognitive-Behaviour therapy (CBT) (The Cognitive Approach to treating Depression)

A
  • Ellis created this
  • To turn irrational thoughts to rational thoughts
  • renamed his therapy rational emotive therapy (RET) because the therapy focused on resolving emotional problems
  • later he changed it to rational emotional behaviour therapy (REBT) because it also resolves behavioural problems
25
Q

What did Ellis extend his ABC model to (The Cognitive Approach to treating Depression)

A

D - disputing the rational and irrational thoughts
E - the effects of disputing and effective attitude to life
F - the new feelings and emotions that are produced

26
Q

How does REBT dispute and challenge the rational thoughts (The Cognitive Approach to treating Depression)

A
  • logic disputing - self - defeating beliefs do not follow logically from the information available (does thinking this way make sense)
  • Empirical disputing - self-defeating beliefs that may no be consistent with reality (where is the proof that this belief is accurate)
  • Pragmatic disputing - emphasises the lack of usefulness of self-defeating beliefs (how is this belief likely to help me)
27
Q

What does effective disputing do (The Cognitive Approach to treating Depression)

A
  • challenges self-defeating beliefs into more rational beliefs
  • client can move from catastrophizing to more rational interpretations
  • makes the client feel better
28
Q

What does homework do in CBT? (The Cognitive Approach to treating Depression)

A

Clients are often asked to complete assignments after sessions and between sessions - might include asking someone out on a date or asking friends to tell them what they really think of them - puts reality to the test and puts rational beliefs into practise

29
Q

What does behavioural activation do in CBT? (The Cognitive Approach to treating Depression)

A
  • Makes depressed clients become more active
  • being active leads to rewards this replaces the depression - characteristic of many depressed people is that they no longer take part in the things that they enjoy
30
Q

What role does unconditional positive regard do in the CBT (The Cognitive Approach to treating Depression)

A
  • Ellis 1994 - important factor is convincing that there client is of worth as a human being
  • if feel worthless they will be less willing to consider changing their beliefs and behaviour - however if they feel respect and appreciation regardless of what the client does this will facilitate a change in beliefs and attitudes
31
Q

Evaluation of The Cognitive Approach to Treating Depression: Research support

A

Ellis 1957 - claimed 90% success rate for REBT taking 27 sessions to complete the treatment
Ellis 2001 - recognised that the therapy was not always effective and suggested this was because clients did not put revised beliefs into action
- REBT and CBT - positive outcomes
- Cuijpers et al 2013 - 75 studies found that CBT was superior to no treatment
- Kuyken and Tsivrikos 2009 - conclude that as much as 15% of the variance in outcome may be attributable to therapist competence

32
Q

Evaluation of The Cognitive Approach to Treating Depression: Individual differences

A

CBT less suitable for those who have high levels of irrational beliefs that are rigid and resistant to change - Elkin et al 1985

  • Simons et al 1995 - CBT not suitable in situations where high levels of stress in the individual reflect realistic stressors in the persons life that therapy cannot resolve
  • some individuals do not get involved in the cognitive effort that is associated with recovery - they prefer to just discuss there problems with a therapist
33
Q

Evaluation of The Cognitive Approach to Treating Depression: Support for behavioural activation

A
  • Babyak et al 2000 - studied 156 adult volunteers with major depressive disorder- were assigned a fourmont course of aerobic exercise, drug treatment or both, all showed significant improvement by the end of the four months. Six months after the exercise group showed less relapses that the medication group
34
Q

Evaluation of The Cognitive Approach to Treating Depression: Alternative treatments

A

use of antidepressants such as SSRI’s most popular treatment

  • drug therapies require less effort on patients behalf
  • could also be used in conjuction with CBT
  • most effective when being used with CBT - Cuijpers et al
35
Q

Evaluation of The Cognitive Approach to Treating Depression: The Dodo bird effect

A

Saul Rosenzweig 1936 - all methods of treatment for mental disorder were pretty much equally effective - called it the Dodo bird effect

  • Luborsky et al 1975, 2002, studied 100 different studies that compared different therapies and found little difference between them - Rosenzwig argued there was a lack of difference because there was so many common factors in the various different treatments
  • Sloane et al 1975 - most common being able to talk to a sympathetic person this will enhance self-esteem and have an opportunity to express one thoughts
36
Q

What are the genetic explanations for explaining OCD (The Biological Approach to explaining OCD)

A

The COMT gene
The SERT gene
Diathesis-stress

37
Q

Explain the role that the COMT gene plays (The Biological Approach to explaining OCD)

A
  • Regulates the production of the neurotransmitter dopamine that is involved in OCD
  • one form of the COMT gene has been found to be more common in OCD patients than people without the disorder
  • Tukel et al 2013 - this produces lower activity of the COMT gene and higher levels of dopamine
38
Q

Explain role that the SERT gene plays (The Biological Approach to explaining OCD)

A
  • effects the transport of the neurotransmitter serotonin creates lower levels of the neurotransmitter
  • these lower levels are involved in OCD
  • Ozaki et al 2003 - found a mutation of this gene in two unrelated families where 6 of the 7 members had OCD
39
Q

Explain the role that the Diathesis-stress plays (The Biological Approach to explaining OCD)

A
  • the idea of a simple link between one gene and OCD is unlikely
  • the SERT gene are implicated in a number of other disorders such as depression and PTSD
  • suggests that each individual gene creates a vulnerability for OCD as well as other conditions such as depression - other factors affect what mental illness could develop
40
Q

What are the neural explanations for the causing of OCD

The Biological Approach to explaining OCD

A
  • Abnormal levels of neurotramitters

- Abnormal Brain circuits

41
Q

Describe abnormal neurotramitters as an explanation of OCD(The Biological Approach to explaining OCD)

A
  • Dopamine levels are though to be abnormally high in people with OCD - based on animal studies
  • Szechtman et al 1998 - high doses of drugs that enhance levels of dopamine induce stereotyped movements resembling the compulsive behaviours in OCD patients
  • lower levels of serotonin are associated with OCD
  • Pigott et al 1990 - this conclusion is to based on the fact that antidepressant drugs that increase serotonin activity have been shown to reduce OCD symptoms
  • Jenicke 1992 whereas antidepressants that have less effect on serotonin do not reduce OCD symptoms
42
Q

Describe Abnormal brain circuits as an explanation of OCD (The Biological Approach to explaining OCD)

A
  • areas in the frontal lobes of the brain are thought to be abnormal in people with OCD
  • The caudate nucleus normally suppresses signals from the orbitofrontal cortex (OFC) then the OFC sends signals to the thalamus about worrying things
  • when the Caudate is damaged it fails to suppress minor worries and the thalamus is alerted and sends signals back to the OFC this is a worry circuit
  • supported by PET scans of OCD patients when symptoms are activated
  • serotonin and dopamine are linked to these regions of the frontal lobes
  • Comer 1998 - reported that serotonin play a key role in the operation of OFC and caudate nucleus therefore abnormal levels will cause these to not function
  • Sukel 2007 - dopamine is also linked to this system - main neurotransmitter of the basal ganglia therefore high levels of dopamine could cause over reaction
43
Q

Evaluation of The Biological Approach to Explaining OCD: Family and Twin studies

A
  • Nestadt et al 2000 - identified 80 patients with OCD and 343 of their first degree relatives and compared them with 73 control patients without a mental illness and 300 of their relatives
  • found that people with a first degree relative with OCD had a five times greater risk of having the illness themselves at some point in their lives compared to the general population
  • Billet et al 1998 - meta analysis of 14 twin studies of OCD found that monozygotic twins (identical) were more than twice as likely to develop OCD is their co-twin had the disorder then dizygotic twins
  • concordance rates are never 100% - environmental factors must also play a role too
44
Q

Evaluation of The Biological Approach to Explaining OCD: Tourette’s syndrome and other disorders

A
  • Pauls and Leckman 1986 - studied patients with Tourette’s syndrome and their families - concluded that OCD is one form of expression of the same gene that determines Tourette’s
  • also found in children with autisms
  • obsessive behaviour is typical of anorexia nervosa and is one of the characteristics distinguishing individuals with anorexia from individuals with bulimia
  • Rasumussen and Eisen 1992 - reported that two out of three patients with OCD experience at least one episode of depression
  • supports view that there is not one specific gene or genes unique to DNA
45
Q

Evaluation of The Biological Approach to Explaining OCD: Research support for genes and OFC

A

Menzies et al 2007 - Used MRI to produce images of brain activity in OCD patients and their immediate family members without OCD and a group of healthy unrelated people
- OCD patients and their family members had reduced grey matter in key regions of the brain including the OFC this support the view that anatomical differences are inherited and these may lead to OCD

46
Q

Evaluation of The Biological Approach to Explaining OCD: Real-world application

A
  • mapping of the human genome led to the hope that specific genes could be linked to particular mental and physical disorders
  • could abort an unborn child with the COMT gene
  • ethically wrong - may lead to designer babies
  • gene therapy could turn these genes off
  • assumes that there is a simple relationship between a disorder and genes - not as simple as that
47
Q

Evaluation of The Biological Approach to Explaining OCD: Alternative explanations

A

Two process model could be used to explain OCD

  • neutral stimuli such as dirt is associated with anxiety and the anxiety is maintained as the stimulus is avoided and an obsession is formed
  • this is supported by success of a treatment for OCD called exposure response prevention (ERP) this is similar to SD - patients experience these stimulus but prevented from carrying out there compulsion
  • Albucher et al 1998 - report that between 60 - 90% of adults with OCD have improved considerably using ERP
48
Q

What drugs are used to treat OCD (The biological approach to treating OCD)

A
  • Most commonly used drugs for OCD are antidepressants, this is because low levels of serotonin are associated with OCD therefore drugs increase the serotonin level
  • Low levels of serotonin may be a factor which cause the worry circuit therefore increasing the levels of serotonin will normalise the worry circuit
  • They also reduce the anxiety associated with OCD
  • SSRIs are currently the preferred drugs for treating anxiety disorders – Choy and Schneier 2008 as it regulates mood and anxiety
  • Serotonin is released into a synapse from one nerve and targets receptor cells on the receiving neuron at receptor sites, afterwards it is re-absorbed by the initial neuron and send the message – in order to increase the serotonin levels the re-absorption is stopped
49
Q

Describe SSRI’s as away to treat OCD (The biological approach to treating OCD)

A
  • The Tricyclic Clomipramine was the first antidepressant to be used for OCD and today is primarily used in the treatment of OCD rather than depression
  • They block the transported mechanisms that re-absorbs both serotonin and noradrenaline into the pre-synaptic cell after it has fired therefore more of the neurotransmitters are left in the synapse this prolongs there activity and eases the transmission of the next impulse
  • They have the advantage of targeting more than one neurotransmitter
  • Greater side effects in comparison to SSRIs so are only used when SSRIs are not effective
50
Q

Describe Tricyclics as a way to treat OCD

The biological approach to treating OCD

A
  • Benzodiazepines (BZs) are commonly used to reduce anxiety, manufactured under various trade names
  • Slow down the activity of the central nervous system by enhancing the activity of the neurotransmitter GABA (gamma-aminobutyric acid) a neurotransmitter when released that has a quietening effect on many of neurons in the brain
  • It does this by reacting with special sites called GABA receptors on the outside of receiving neurons, when GABA locks into these receptors it opens a channel that increases the flow of chloride ions into the neuron
  • Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, this slows down activity making the person feel more relaxed
51
Q

Describe other drugs to treat OCD (The Biological Approach to Treating OCD)

A
  • Research found that D-Cycloserine has an effect on reducing anxiety and thus may be an effective treatment for OCD, its more effective when used in conjuction with psychotherapy
  • It is also an antibiotic used to treat TB, and enhances transmission of GABA reducing anxiety
52
Q

Evaluation of the Biological Approach to treating OCD: Effectiveness

A
  • Soomro et al 2008 – reviewed 17 studie of the use of SSRIs with OCD patietns and found them to be more effective than using placebos in reducing OCD up to three months after treatment so good in the short term
  • Koran et al – one problem with placebo studies is they are only for three to four months duration therefore there is no long-term data
53
Q

Evaluation of the Biological Approach to treating OCD: Drug therapies are preferred to other treatments

A
  • Requires little effort from the user
  • Less time than other therapies such as CBT – attend sessions and put thought into what there doing
  • Cheaper
  • Require little monitoring
  • May benefit from just talking with a doctor during a consultation
54
Q

Evaluation of the Biological Approach to treating OCD: Side effects

A
  • All drugs have side effects some more serve than others
  • Nausea, headache, insomnia are all side effects of SSRIs – Soomro et al
  • Tricyclic antidepressants have more side effects – hallucinations and irregular heartbeats – only used when SSRIs not effective
  • BZs cause people to be aggressive and have long-term impairment of memory, also addictive so can only be used for 4 months
55
Q

Evaluation of the Biological Approach to treating OCD: Not a lasting cure

A
  • Koran et al 2007 – in a review of treatments for OCD he suggested that although drug therapies are more common, psychotherapies such as CBT should be tried first as it can be more long term
  • Patients are more likely to relapse after a couple of weeks of not taking the cure
56
Q

Evaluation of the Biological Approach to treating OCD: Publication bias

A
  • Turner et al 2008 – claimed that there is evidence of a publication bias towards studies that show a positive outcome of drug therapy and exaggerates the benefits of antidepressant drugs
  • Published papers which showed a non-positive outcome were often published in a way that seemed positive
  • Drug companies also have a strong interest
  • Selective publication can also lead doctors to make an inappropriate treatment decision not in the best interest of their patients

Psychology (37 decks)

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