Psychopathology - quizlet Flashcards
1
Q
Name the four indicators of a psychological disorder
A
- Statistical deviation/infrequency - Deviation from social norms - Failure to function adequately - Deviation from ideal mental health
2
Q
Define statistical infrequency
A
A mathematical method for defining abnormality, based on the idea that if something occurs rarely then it is abnormal. (ie: being more depressed or less intelligent than the majority of the population)
3
Q
Give some examples of psychological disorders or behaviours that are statistically infrequent
A
- Intellectual disability disorder (having an IQ below 70) - Schizophrenia (1 in 100 people have this) - OCD (1 in 100 people have this)
4
Q
What is standard deviation?
A
A measure that informs us how far scores fall on either side of the central average (aka: the mean)
5
Q
How does standard deviation help us to see abnormalities?
A
Human attributes fall into a normal distribution within the population. This is displayed by the central average (mean). The rest of the population falls symmetrically above and below the mean. If a characteristic falls more than 2 standard deviations away from the mean then it is considered abnormal.
6
Q
Use statistical deviation to explain how we can tell when someone’s IQ is abnormal , indicating intellectual disability disorder
A
- The average IQ is 100 - For IQ, 68% of people fall within one standard deviation from the mean - The standard deviation for IQ is 15, so 68% of the population score between 85 and 115 on an IQ test - For IQ, 95% of people fall within two standard deviations from the mean - The standard deviation for IQ is 15, so 95% of the population score between 70 and 130 on an IQ test - Anybody scoring lower of higher than this range would be considered abnormal
7
Q
What is a social norm?
A
The explicit and implicit rules that a society has about what behaviours and values are appropriate
8
Q
What is the difference between implicit and explicit rules (in terms of social norms)
A
Implicit rules relate to behaviours which are socially acceptable (ie: standing too close to somebody when talking to them) Explicit rules relate to actions that violate the law and could send someone to prison (ie: murder)
9
Q
Give an example of a disorder that is identified using deviation from social norms
A
Antisocial personality disorder (psychopathy) is identified by recognising impulsive, aggressive and irresponsible behaviour. People with this disorder fail to conform to lawful or culturally normative ethical behaviour.
10
Q
When might we decide that someone is failing to function adequately?
A
- They are unable to maintain basic standards of nutrition and hygiene. - They cannot hold down a job - They are unable to maintain relationships with those around them
11
Q
Who proposed seven criteria for ‘failing to function adequately’?
A
Rosenhan and Seligman (1989)
12
Q
What were Rosenhan and Seligman’s seven criteria for failing to function adequately? Displaying a great number of these is indication of a psychological disorder
A
- Suffering - Maladaptiveness (engages in behaviours that make it difficult for them to lead their normal life) - Irrational - Observer discomfort (others find the person’s behaviour uncomfortable to watch) - Vividness (unconventionality) - Violation of moral codes - Unpredictability
13
Q
Who proposed criteria for ideal mental health, so we are able to recognise deviation from it?
A
Marie Jahoda (1958)
14
Q
What did Marie Jahoda suggest good mental health looks like?
A
- Positive view of self - Independent and self regulating - Having an accurate view of reality - Resistant to stress - Able to adapt to environment - Works toward self actualisation (the best version of yourself)
15
Q
What is a strength of defining abnormality via statistical deviation?
A
Real life application
16
Q
What are the real life applications of statistical deviation?
A
All assessment of of patients with mental disorders includes some kind of measurement of how severe their symptoms are as compared to statistical norms (as well as social norms)
17
Q
What are the weaknesses of defining abnormality via statistical deviation?
A
- Unusual characteristics may actually be positive - Giving someone a label may not be beneficial for them
18
Q
Give an example of a statistically abnormal characteristic actually being positive
A
An IQ score over 130
19
Q
Why would not everyone benefit from being labelled as abnormal?
A
If someone is living a happy and fulfilled life, there would be no benefit to them being labelled as abnormal, no matter how unusual they are. Being labelled may have a negative effect on how others view them and how they view themselves.
20
Q
What is a strength of defining abnormality via deviation from social norms?
A
It takes into account the desirability of the behaviour. This contrasts with statistical deviation. According to statistical deviation, someone with abnormally high IQ may be considered negative. According to deviation from social norms, however, having an abnormally high IQ would not be a problem.
21
Q
What are the weaknesses of defining abnormality via deviation from social norms?
A
- Cultural relativism - Can lead to human rights abuses
22
Q
Why is cultural relativism a weakness of deviation from social norms?
A
Social norms vary greatly between generations and communities so what one person sees as abnormal (and therefore an indicator of mental illness) may actually be an ordinary behaviour in another culture.
23
Q
Give an example of when abnormal behaviour has been used to fuel systemic human rights abuses
A
- Drapetomania was used to describe the behaviour of Black slaves who tried to run away - Nymphomania was used to describe women having sexual attraction to working class men
24
Q
What is a strength of defining abnormality via failure to function adequately?
A
It takes into account the patient’s subjective experience
25
What are the weaknesses of defining abnormality via failure to function adequately?
- It can be hard to tell the difference between failing to function and deviating from social norms - Judging whether someone is functioning adequately requires a subjective judgement - It doesn't take into account 'high functioning' people with a mental illness
26
Give an example of why being unable to tell the difference between failing to function adequately and deviation from social norms is a problem
- Someone not having a job or a permanent address could be a sign of not functioning adequately, or it could just be someone choosing to lead an alternate lifestyle - Someone practicing an extreme sport may be behaving in a maladaptive way - People with religious beliefs could be labelled as irrational
27
What is a strength of defining abnormality via deviation from ideal mental health?
It is very comprehensive and covers a broad range of criteria
28
What are the weaknesses of defining abnormality via deviation from ideal mental health?
- Cultural relativism - Setting an unrealistically high standard for mental health
29
Why is cultural relativism a problem for deviation from ideal mental health?
- Some of Jahoda's ideas are specific to Western European and North American cultures - ie: self actualisation and independence may be seen as good things in individualist cultures but bad things in collectivist cultures
30
What is a phobia?
An excessive fear triggered by an object, place or situation. The extent of ear is out of proportion to any real danger presented by the phobic stimulus
31
Define a 'specific phobia'
Phobia of an object (eg: animal or body part) or a situation (eg: flying or having an injection)
32
Define social anxiety
Phobia of a social situation such as public speaking or using a public toilet
33
Define agoraphobia
Phobia of being outside or in a public space
34
What is arachnophobia?
Phobia of spiders
35
What is ophidiophobia?
Phobia of snakes
36
What is coulrophobia?
Phobia of clowns
37
Name the three fear responses that a phobic stimulus could trigger
- Panic - Avoidance - Endurance
38
What behaviours may panic involve?
- Crying - Screaming - Running away - Freezing - Having a tantrum
39
Give an example of avoiding a phobic stimulus
Someone with a fear of public toilets may have to limit the amount of time they spend outside home in relation to how long they can last without a toilet. This could interfere with work, education and social life
40
Give an example of enduring a phobic stimulus
Someone with a phobia of flying may get on a flight out of necessity but feel extremely high levels of anxiety throughout.
41
What are the emotional characteristics of having a phobia?
- Anxiety - Disproportionate emotional response
42
What is the difference between anxiety and fear when it comes to phobias?
Anxiety is an unpleasant state of high arousal that prevents the sufferer from relaxing and experiencing and positive emotion. Fear is the immediate and extremely unpleasant response experienced when we encounter or think about the phobic stimulus.
43
For someone with arachnophobia, when would they feel anxiety and when would they feel fear?
Anxiety: increases when entering a place associated with spiders (eg: the zoo, garden shed) Fear: felt on actually seeing a spider
44
What does the cognitive element of a phobia focus on?
How people process information
45
Name the three cognitive characteristics of phobias
- Selective attention to the phobic stimulus - Irrational beliefs - Cognitive distortions
46
Why are some people unable to look away from a phobic stimulus?
If something is a threat to us, it is a good thing to keep our attention on it as this gives us the best chance of survival. Because the phobic stimulus is perceived as a threat, the sufferer will be unable to focus on anything else.
47
What are cognitive distortions?
The phobic's perception of the phobic stimulus may be distorted.
48
Name 4 categories of depression
- Major depressive disorder - Persistent depressive disorder - Disruptive mood dysregulation - Premenstrual dysphoric disorder
49
What is major depressive disorder?
Severe but short term depression
50
What is persistent depressive disorder?
Long term recurring depression, including sustained major depression
51
What is disruptive mood dysregulation?
Childhood temper tantrums
52
What is premenstrual dysphoric disorder?
Disruption to mood prior to and/or during menstruation
53
What are all forms of depression characterised by?
Changes to mood
54
Name the 3 behavioural characteristics of depression
- Change in activity levels - Disruption to sleep and eating behaviour - Aggression and self harm
55
What does depression typically do somebody's activity levels?
It normally reduces their energy. This can cause someone to withdraw from work, education and social life.
56
What is it called when depression causes more activity?
Psychomotor agitation. Individuals may struggle to relax.
57
How can depression affect sleep?
- Insomnia: decreased sleep - Hypersomnia: increased sleep
58
Name 3 emotional characteristics of depression
- Lowered mood - Anger - Lowered self-esteem
59
What can anger caused by depression often lead to?
Self harm or self harming behaviours
60
Name the 3 cognitive characteristics of depression
- Poor concentration - Attending to and dwelling on the negative - Absolutist thinking
61
What does attending to and dwelling on the negative mean?
- Sufferers focus more on the negative aspects of a situation than the positive - Sufferers are more likely to recall unhappy events rather than happy ones
62
What do OCD and its related disorders have in common?
Repetitive behaviour accompanied by obsessive thinking
63
What does OCD involve?
Obsessions and compulsions
64
What is trichotillomania?
Compulsive hair pulling
65
What is hoarding disorder?
The compulsive gathering of possessions and the inability to part with anything, regardless of its value
66
What is excoriation disorder?
Compulsive skin picking
67
Name the 2 behavioural characteristics of OCD
- Compulsions - Avoidance
68
What are the 2 elements to compulsive behaviours?
- They are repetitive - They reduce anxiety
69
Give some examples of common OCD compulsions
- Hand washing - Counting - Praying - Tidying/ordering objects
70
Why do compulsions reduce anxiety?
They are an attempt to manage anxiety produced by an obsession. Eg: Compulsive hand washing is carried out as a response to obsessive fear of germs
71
Why is avoidance a behavioural characteristic of OCD?
OCD sufferers attempt to reduce their anxiety by keeping away from the obsessions that trigger it. Eg: Compulsive hand washers may avoid coming into contact with germs
72
Name the emotional characteristics of OCD
- Anxiety and distress - Accompanying depression - Guilt and disgust
73
What creates anxiety for OCD sufferers?
- Obsessive thoughts - The urge to repeat a behaviour (compulsion)
74
Name the cognitive characteristics of OCD
- Obsessive thoughts - Cognitive strategies to deal with obsessions - Insight into excessive anxiety
75
Give some examples of obsessive thoughts
- Worries of being contaminated by dirt - Certainty that a door has been left unlocked - Impulses to hurt someone
76
Give an example of cognitive strategies that could be used to deal with obsessions
A religious person tormented by obsessive guilt may respond by praying or meditating. This may appear abnormal to others.
77
What is a key difference between OCD and other mental disorders such as schizophrenia?
People suffering from OCD are aware that their obsessions and compulsions are not rational.
78
What can anxiety caused by OCD lead sufferers to be?
Hypervigilant (focuses on any potential hazards)
79
What does the behavioural approach focus on?
The role of learning in the acquisition of behaviour
80
Who proposed the two process model for phobias?
Hobart Mowrer (1960)
81
What was the two-process model? (short definition)
It states that phobias are acquired by classical conditioning then continue because of operant conditioning.
82
What is classical conditioning?
It is learning through association. It occurs when two stimuli are repeatedly paired together - an unconditioned stimulus and a new neutral stimulus. The neutral stimulus eventually produces the same response that was first produced by the unconditioned stimulus alone.
83
Who conducted the 'Little Albert' experiment?
Watson and Raynor (1920)
84
What was the aim of the 'Little Albert' experiment?
To see how phobias are formed
85
Outline the procedure of the 'Little Albert' experiment
A nine month old baby (Albert) showed no unusual anxiety at the start of the study and wanted to play with a white rat when it was shown to him. The experimenters gave Albert a phobia by making a loud, frightening noise using an iron bar whenever the rat was presented.
86
Explain the 'Little Albert' experiment in terms of classical conditioning
The was an unconditioned stimulus that created an unconditioned fear response to it. The rat (neutral stimulus) and the unconditioned stimulus were encountered close together so that, in time, they produce the fear response together. Albert became afraid when he saw the rat as the rat became the conditioned stimulus. His fear was the conditioned response.
87
What other objects did Albert become afraid of?
- Non-white rabbit - Fur coat - Watson wearing a Santa Claus beard made out of cotton balls
88
Operant conditioning takes place when our behaviour is (a) or (b)
- Reinforced - Punished
89
What type of reinforcement/punishment occurs when a sufferer avoids a phobic situation?
Negative reinforcement
90
How does operant conditioning make a phobia long lasting?
When someone avoids a phobic stimulus they successfully escape the fear and anxiety that they would have suffered if they remained. This reduction in fear negatively reinforces the avoidance behaviour so the phobia is maintained.
91
Name 2 strengths of the two process model
- Practical applications - Link between phobias and traumatic experiences
92
Explain the practical applications of the two step model
It explains why patients need to be exposed to the feared stimulus (so that their avoidance behaviour is not reinforced) so has real life applications for therapy
93
What evidence is there for a link between bad experiences and phobias?
- The Little Albert study shows how a frightening experience involving a stimulus can lead to a phobia of that stimulus - Ad De Jongh et al (2006) conducted a study that found 73% of people with fear of dental treatment had gone through a traumatic experience, most likely involving dentistry. A control group who had not experienced a traumatic event only had a 21% rate of dental anxiety.
94
Name the weaknesses of the two-process model
- An alternative explanation for avoidance behaviour - An incomplete explanation of phobias - Some phobias don't follow a trauma
95
What is an alternative explanation for avoidance behaviour?
- Some avoidance behaviour is motivated more by positive feelings of safety rather than anxiety reduction Eg: - For an agoraphobic person, not leaving the house is not so much to avoid the phobic stimulus but to stick with the safety factor - This explains why some agoraphobic patients can leave their house with a trusted person or relative without feeling much anxiety, but not alone
96
What elements of phobias need further explanation?
Cognitive
97
How are the cognitive aspects of phobias not covered properly?
- Behavioural explanations (eg: two process model) are geared toward explaining behaviour, which is most often avoiding the phobic stimulus - Phobias are not just avoidance responses so the cognitive component of them must be explained as well - The two process model explains avoidance behaviour but not other things such as irrational beliefs about the phobic stimulus
98
Give an examples of how phobias don't follow a trauma
- Common phobias such as snake phobias occur in populations where very few people have any experience of snakes - Some traumatic events don't lead to phobias
99
Why is it a weakness that some traumatic events don't lead to phobias?
It means the association between phobias and frightening experiences is not as strong as we would expect
100
What are the two behavioural methods of treating phobias?
- Systematic desensitisation - Flooding
101
Define systematic desensitisation
A behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning. If a person can learn to relax in the presence of the phobic stimulus then they will be cured.
102
What is the learning of a different response called?
counterconditioning
103
What are the 3 processes involved in systematic desensitisation?
- Anxiety hierarchy - Relaxation - Exposure
104
What is the anxiety hierarchy?
- Put together by the client with a phobia and their therapist - A list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening
105
Give an example of an anxiety hierarchy for someone afraid of the sea
- A picture of the sea - A video of the sea - Standing near the sea - On a boat on the sea - Swimming in the sea - Staying underwater for a period of time in the sea
106
What is involved in the relaxation stage of systematic desensitisation?
The therapist teaches the client to relax as deeply as possible. This might involve... - Breathing exercises - Mental imagery techniques - Meditation - Drugs such as Valium
107
What is the official term for the idea that a person cannot be in two opposing states at once (ie: scared and relaxed)?
Reciprocal inhibition
108
How is reciprocal inhibition relevant to systematic desensitisation?
By making their clients as relaxed as possible, therapists eliminate the chance of them experiencing fear at the same time. This can be utilised for when the client comes into contact with the phobic stimulus.
109
What is involved in the exposure stage of systematic desensitisation?
- The client is exposed to the phobic stimulus while in a relaxed state - This takes place across several sessions, starting at the bottom of the anxiety hierarchy - When the client stays relaxed in the presence of lower levels of the phobic stimulus, they can move up the hierarchy - The treatment is complete when the client can stay relaxed at the top of the anxiety hierarchy
110
Name the strengths of systematic desensitisation
- Evidence of effectiveness - People with learning disabilities
111
Name the weaknesses of systematic desensitisation
- It ignores certain factors that could contribute to phobias - It is more appropriate for some phobias than others
112
What evidence is there of the effectiveness of systematic desensitisation?
- Lisa Gilroy et al (2003) followed up 42 people who had systematic desensitisation for spider phobia in three 45 minute sessions - At both 3 and 33 months, the systematic desensitisation group were less fearful than a control group treated by relaxation without exposure
113
How do people with learning disabilities support systematic desensitisation?
- Some people requiring treatment for phobias also have a learning disability - Cognitive therapies that require complex rational thought are often not appropriate to treat these people. Flooding may also be too distressing and traumatic for them - This means that systematic desensitisation is the most appropriate treatment for people with learning disabilities who have phobias
114
How does systematic desensitisation not address certain factors that can cause phobias?
- Cognitive factors such as irrational beliefs and distortions of the phobic object are not addressed
115
Why is it a problem that systematic desensitisation doesn't address cognitive factors of phobias?
- The effects may not be as long lasting as it doesn't delve as deep as it could
116
What type of phobia is systematic desensitisation better for?
- Simpler phobias (such as arachnophobia) rather than complex ones like social phobias
117
Why is systematic desensitisation better for simpler phobias?
It would be more practically difficult to gradually expose people to different levels of social interaction, for example
118
Define flooding
A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce the anxiety it triggers
119
How long does a flooding session usually last for?
- Until the patient is relaxed - Often 2 - 3 hours
120
How could flooding be used on someone with arachnophobia?
A large spider might crawl over them for an extended period
121
Explain how flooding works
- A person's fear response has a limited duration - As anxiety levels naturally decrease, a new stimulus response link can be formed between the feared stimulus and relaxation (this is called extinction) - Some patients become relaxed due to exhaustion
122
What ethical safeguards are required for flooding?
It is a very unpleasant experience, so it is important patients give fully informed consent and are prepared.
123
What are the strengths of flooding?
- Cost-effective
124
What are the weaknesses of flooding?
- Is less suited to complex phobias - It is highly traumatic
125
Why is flooding cost-effective?
- It can work in as little as one session (as opposed to around 10 sessions for systematic desensitisation) - Ougrin (2011) compared flooding to cognitive therapies and found that it is just as effective
126
How is flooding not as suitable for more complex phobias?
- Social phobias have cognitive aspects - Eg: a sufferer of a social phobia doesn't only experience an anxiety response, but thinks unpleasant thoughts about the social situation - Cognitive therapies would be more useful in this instance
127
What does the traumatic nature of flooding lead to a high rate of?
Attrition (people dropping out of the therapy)
128
What are the two cognitive approaches to explaining depression?
- Beck's negative triad - Ellis' ABC model
129
What 3 things did Beck suggest make a person more vulnerable to depression?
- Faulty information processing - Negative self schemas - The negative triad
130
What is involved in faulty information processing?
- Depressed people often attend to the negative aspects of a situation rather than the positive - Depressed people may blow problems out of proportion - Depressed people may see things in 'black and white' terms
131
What is a schema?
- A package of ideas and information developed through experience - They act as a mental framework for the interpretation of sensory information
132
What is a self schema?
The package of information we have about ourselves
133
What is the negative triad?
- The three types of negative thinking that occur automatically, regardless of the reality of the situation
134
What are the components of the negative triad?
- Negative view of the world - Negative view of the future - Negative view of the self
135
What does negative view of the world involve?
Thinking about: - The state of the world - What other people are like - How others treat you
136
What does negative view of the future involve?
- Hopeless, despairing beliefs about what will or won't happen
137
What does negative view of the self involve?
- Beliefs about the kind of person you are - Views of what we can/can't do
138
What are the strengths of Beck's theory?
- Supporting research - Practical applications
139
What are the weaknesses of Beck's theory?
- It fails to explain where negative thinking comes from
140
What supporting research is there for Beck's theory?
- Clark and Beck concluded that cognitive vulnerabilities (such as faulty information processing, negative self-schemas, the negative triad) are more common in depressed people and preceded the depression - Cohen et al tracked the development of 473 adolescents, regularly measuring their cognitive vulnerability. They found that showing cognitive vulnerability predicted later depression - Grazioli and Terry measured negative thinking patterns in 65 pregnant women. They found that women with a high cognitive vulnerability were more likely to suffer with post natal depression
141
What are the practical applications of Beck's theory?
- The cognitive ideas have been used to develop effective treatments for depression, including CBT - Therapy looks to challenge negative views (ie: the negative triad)
142
Why is it a problem that Beck's theory fails to explain where negative thinking comes from?
- It ignores important factors such as genetics, brain chemistry, upbringing, social class, etc - It doesn't help prevent depression in any way; just identifies it
143
What did Ellis say good mental health is the result of?
Rational thinking that allows people to be happy and free from pain
144
What did Ellis define irrational thoughts as?
Any thoughts that interfere with us being happy or free from pain
145
What does the ABC model stand for?
- Activating event - Beliefs - Consequences
146
What is the activating event?
- An external event that triggers irrational thoughts - Eg: failing a test or ending a relationship
147
Give 3 examples of irrational beliefs Ellis identified
- Musturbation: belief that we must always achieve perfection - I-can't-stand-it-itis: belief that it is a major disaster if something doesn't go smoothly - Utopianism: belief that life is always meant to be fair
148
What are the consequences in Ellis' theory?
When an activating event triggers irrational beliefs there are emotional and behavioural consequences eg: if someone believes they must always succeed, and then fails at something - it can cause depression
149
What is a healthy thought process (according to Ellis)?
Activating event --> Rational belief --> Healthy negative emotion
150
What is an unhealthy thought process (according to Ellis)?
Activating event --> Irrational belief --> Unhealthy negative emotion
151
What is a strength of Ellis' theory?
- Real world application
152
What are the weaknesses of Ellis' theory?
- Reactive and endogenous depression - Ethical issues
153
What are the real world applications of Ellis' theory?
- Ellis' method for treating depression is called Rational Emotive Behaviour Therapy. - There is some evidence that it is able to change the negative beliefs of depressed people
154
Define reactive and endogenous depression
Reactive: depression as a result of an external factor Endogenous: depression as a result of no external factor
155
Why is it a problem that Ellis' ABC model only caters to reactive depression?
- It should look at all cases of depression: even the ones that don't seem to be caused by a specific event
156
What are the ethical issues with Ellis' ABC model?
It places the responsibility of depression solely on the depressed person. This effectively blames them, which is unfair
157
What are the two cognitive methods of treating depression?
- Beck's cognitive therapy - Ellis' rational emotive behaviour therapy
158
What is cognitive behaviour therapy?
A method for treating mental disorder based on both cognitive and behavioural techniques
159
What is involved in the cognitive element of CBT?
It begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the client's problems. They jointly identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge
160
What is involved in the behaviour element of cognitive therapy?
CBT involves working to change negative and irrational thoughts in order to put more effective behaviours in place
161
What does Beck's cognitive therapy aim to do?
Replace negative and irrational thoughts with more positive and rational ones
162
How does Beck's cognitive therapy work?
- Patients participate in thought catching: identifying automatic irrational thoughts about the self, world and future - The negative thoughts are challenged - The patient might be set homework tasks to test the validity of their negative beliefs
163
Give an example of a homework task that could be set for someone undergoing Beck's cognitive therapy
- They have to record when they enjoyed an event or when people were nice to them
164
What do the homework tasks provide?
- Evidence against the patient's negative thoughts, making the patient into a scientist - It encourages the patient to participate in everyday life, providing behavioural activation
165
What does REBT do with the ABC model?
Expands it to the ABCDE model
166
What do D and E stand for (as add ons to the ABC model)?
D: disputing E: effect
167
What is the central technique for REBT?
To identify and dispute irrational thoughts
168
How would an REBT therapist react if a patient talks about how unfair things seem?
- They would identify this as examples of utopianism and challenge it as an irrational belief - This would involve vigorous argument
169
What does the REBT therapist aim to achieve?
To break the link between negative life events and depression
170
Name the 3 different methods of disputing identified by Ellis
- Empirical argument - Logical argument - Pragmatic argument
171
What does empirical argument involve?
Disputing whether there is actual evidence to support the negative belief
172
What does logical argument involve?
Disputing whether the negative thought logically follows the facts
173
What does pragmatic argument involve?
Emphasising the lack of usefulness of self-defeating beliefs
174
What are the strengths of CBT?
- Evidence to support effectiveness - Cost-effective
175
What are the weaknesses of CBT?
- Not suitable for all clients - Success may be due to patient therapist relationship - Cognitions are overemphasised - Some patients may want to explore their past - Relapse rates
176
What evidence supports CBT?
- March et al compared CBT to antidepressant drugs and to a combination of both treatments when treating 337 depressed adolescents. - After 36 weeks, 81% of the antidepressants group and 86% of the antidepressant plus CBT group were significantly improved. - CBT was just as effective when used on its own and more so when used alongside antidepressants
177
Why is CBT cost effective?
It is a fairly brief therapy that usually requires 6 to 12 sessions
178
Who has it been suggested that CBT is not effective for?
- Severe cases of depression - People with learning disabilities
179
Why might CBT not be effective for people with severe depression?
- They might not be able to motivate themselves to engage with the cognitive work of CBT - They may not be able to pay attention to what is happening in a session
180
Why might CBT not be suitable for people with learning disabilities?
It involves complex rational thinking
181
Why might successful CBT be down to patient-therapist relationship rather than the actual effectiveness of the treatment?
- Luborsky's study reviewed multiple psychotherapies (including CBT) and found very small differences between their methods - This means that it might be down to the therapist rather than the individual method
182
How are cognitions overemphasised in CBT?
If someone is living in maladaptive circumstances, simply changing thinking patterns won't be enough to rid them of depression. This lack of success may lead the patient to believe that they are not strong enough to fight their mental illness and could make it worse.
183
Explain how CBT doesn't help patients explore their past
- It only look at combatting current negative thoughts; not past ones
184
Why is it a weakness that CBT doesn't help patients explore their past?
Patients may not be able to explore things that could help them recover
185
What recent study suggests that CBT's effects are not as long lasting as hoped?
Shehzad Ali et al
186
What did Shehzad Ali et al find?
- Assessed depression in 439 clients every month for 12 months following a course of CBT - 42% of clients relapsed into depression within 6 months of ending treatment - 53% relapsed within a year
187
Define biological approach
A perspective that emphasises the importance of physical processes in the body such as genetic inheritance and neural function
188
What is involved in in individual vulnerability to OCD?
Genes
189
Who's study suggests that OCD runs in families?
Lewis (1936)
190
What did Lewis' study find?
Of Lewis' OCD patients, - 37% had parents with OCD - 21% had siblings with OCD
191
What does the diathesis-stress model state?
- Certain genes leave some people more likely to develop a mental disorder but it is not certain - Some environmental stress is necessary to trigger the condition
192
What are the three genetic explanations for OCD?
- Candidate genes - OCD is polygenic - Different types of OCD
193
What are candidate genes?
Genes that researchers have identified that create vulnerability for OCD
194
What are candidate genes often involved in?
Regulating the development of the serotonin system
195
Give an example of a candidate gene
- 5HT1-D beta is implicated in the transport of serotonin across synapses
196
OCD is polygenic. What does polygenic mean?
It means that OCD is not caused by one single gene but by a combination of genetic variations that gather together significantly to increase vulnerability
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Who studied the genes that may cause OCD?
Taylor (2013)
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What were Taylor's findings?
Taylor analysed findings of previous studies and found evidence that up to 230 different genes may be involved in OCD
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What types of genes have been studied in relation to OCD?
- Those associated with the action of dopamine - Those associated with the action of serotonin - Both of these are neurotransmitters involved in regulating mood
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One group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person. What is the term used to describe this?
Aetiologically heterogeneous
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Give an example of a type of OCD that may be a result of particular genetic variations
- Hoarding disorder - Religious obsession
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What is a strength of the genetic explanations for OCD?
There is a lot of strong evidence
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Give some examples of the strong evidence for genetic explanations of OCD
- Twin studies. Nestadt reviewed twin studies and found that 68% of identical twins (MZ) shared OCD as opposed to 31% of non-identical twins (DZ) - Family studies. Marini and Stebnicki found that a person with a family member diagnosed with OCD is around four times as likely to develop it as someone without
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Name the weaknesses of the genetic explanations of OCD.
- Environmental risk factors - Identifying specific genes that cause OCD - Animal studies
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Why are environmental risk factors a weakness of the genetic explanations of OCD?
- They suggest that OCD isn't entirely biologically influenced - Cromer's study found that over half the OCD clients in their sample had experienced a traumatic event in their past - OCD is often more severe in those with traumas - Genetic vulnerability only provides a partial explanation for OCD
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Why are psychologists unable to identify the specific genes that cause OCD?
There are probably several genes involved and each genetic variation only increases the risk of OCD by a fraction
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Why is the fact that scientists can't identify the specific genes that cause OCD a weakness of the theory?
It means the genetic explanation doesn't have as much predictive volume
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Why are animal studies a weakness of the genetic explanations of OCD?
Although animal studies show that particular genes are associated with repetitive behaviours in other species (eg: Ahmari 2016 studied mice), the human mind is much more complex than mice. It therefore may not be possible to generalise from animal repetitive behaviour to human OCD.
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What are neural explanations?
The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain
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Name the two neural explanations for OCD
- The role of serotonin - Decision making systems
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What is serotonin?
A neurotransmitter believed to help regulate mood
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What are neurotransmitters responsible for?
Relaying information from one neuron to another
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What happens if someone has low levels of serotonin?
- Normal transmission of mood-relevant information does not take place - They may experience low moods - Other mental processes may be affected
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Explain how there may be less serotonin in OCD sufferers.
- Scientists believe that people with OCD have a genetic mutation that produces an abnormally high amount of serotonin uptake receptors on the sending neuron - This means that too much serotonin gets reabsorbed back into the sending cell so not enough is left in the synapse for transmission
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Give an example of a type of OCD associated with impaired decision making
Hoarding disorder
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Which parts of the brain will be functioning abnormally if decision making is affected?
- The lateral (side bits) of the frontal lobes - Are responsible for logical thinking and decision making - The parahippocampal gyrus - Associated with processing unpleasant emotions
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Name the strength of the neural explanations of OCD
- Research support
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Name the weaknesses of the neural explanations of OCD
- It isn't clear which neural mechanisms are involved - Co-morbidity
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What research support is there for the neural explanations of OCD?
- Antidepressants that work purely on serotonin are effective in reducing OCD symptoms and this suggests that serotonin may be involved in OCD - OCD symptoms form part of conditions that are known to be biological in origin, such as Parkinson's disease that causes muscle tremors and paralysis (Nestadt et al, 2010)
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What is co-morbidity?
Having two disorders together
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Why does co-morbidity weaken the neural explanations of OCD?
- Many people with OCD also experience clinical depression - The depression probably involves (though is not necessarily caused by) disruption to the action of serotonin - This could mean that serotonin activity is disrupted in many people with OCD because they are depressed as well - This means serotonin may not even be relevant to OCD symptoms
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Why isn't it clear which neural mechanisms cause OCD?
- Cavedini et al's study found that decision making neural systems are the ones that function abnormally in OCD - Other research has identified other brain systems that may be involved - No one single system has always been found responsible
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Why is the lack of clarity surrounding the mechanisms causing OCD a weakness of the neural explanations?
It means more research need to be done
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What is drug therapy?
Treatment involving drugs (ie: chemicals that have a particular effect on the functioning of the brain or some other bodily system)
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What does drug therapy for mental disorders aim to do?
To increase/decrease levels of neurotransmitters in the brain or increase/decrease their activity
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What do drugs used to treat OCD usually do?
Work in various ways to increase the level of serotonin in the brain.
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Name the 3 types of biological approach to treating OCD
- SSRIs - Combining SSRIs with other treatments - Alternatives to SSRI drugs such as tricyclics and SNRIs
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What is a neurotransmitter?
A chemical substance released at the end of a nerve fibre by the arrival of a nerve impulse
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What does SSRI stand for?
Selective serotonin reuptake inhibitor
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What happens to serotonin in the brain?
- It is released by the presynaptic neurons and travels across a synapse - The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron - It is reabsorbed by the presynaptic neuron where it is broken down and reused
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How do SSRIs increase levels of serotonin in the synapse?
They prevent the reabsorption and breakdown of serotonin, continuing to stimulate the post synaptic neuron.
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Give an example of an SSRI
Fluoxetine (eg: brand name Prozac)
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What is a typical daily dose of fluoxetine?
20mg, although this can be increased if it is not benefitting the person
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In what form is fluoxetine available?
Capsules or liquid
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How long does it take for SSRIs to have much impact on symptoms?
Three to four months of daily use
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What is often used alongside SSRIs to treat OCD?
- Drugs - Cognitive behaviour therapy
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What do drugs used to treat OCD alongside SSRIs do?
Reduce a person's emotional symptoms, such as feeling anxious or depressed. This means that people can engage more effectively with the CBT.
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Some people respond best to (a) alone whilst others benefit more when additionally using (b) like (c).
a) CBT b) drugs c) fluoxetine
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Give two examples of alternative drugs that can be used if SSRIs don't work
- Tricyclics - SNRIs
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What are tricyclics?
An older type of antidepressant
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Give an example of a type of tricyclic
Clomipramine
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What does clomipramine do?
Acts on various systems including the serotonin system where it has the same effect as SSRIs
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Why is clomipramine not regularly used?
It has more severe side effects
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What does SNRI stand for?
Serotonin-noradrenaline reuptake inhibitors
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What do SNRIs do?
Increase levels of serotonin as well as another different neurotransmitter - noradrenaline
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Name the strengths of the biological approach to treating OCD
- Clear evidence for effectiveness - Cost effective and non-disruptive
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Name the weaknesses of the biological approach to treating OCD
- Serious side effects - Biased evidence
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What evidence is there for the effectiveness of drug treatments for OCD?
- Soomro et al reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD. All 17 studies showed significantly better outcomes for the SSRIs than for the placebo conditions. - Typically, symptoms reduce for for around 70% of people taking SSRIs. The remaining 30% can be helped by either alternative drugs or combinations of drugs and psychological therapies.
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Why are drug treatments cost effective?
- They are cheap compared to psychological treatments - Many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy
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How are drug treatments non-disruptive?
If you wish to take drugs you can simply take drugs until your symptoms decline. This is different form psychological therapy, which involves time spent attending therapy sessions.
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What are some of the side effects of drug treatments for OCD?
SSRIs: - Indigestion - Blurred vision - Loss of sex drive Clomipramine: - Erection problems - Weight gain - Aggression - Heart related problems
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Why might evidence for the effectiveness of drugs be biased?
Some psychologists believe that researchers are sponsored by drug companies and may selectively publish positive outcomes for the drugs their sponsors are selling.
