Psychopatholoy Flashcards
Explaining depression
The view that depression is linked to irrational thinking is supported by research. Hammen and Krantz (1976) found that depressed participants made moe errors in logic when asked to interpret written material than did non-depressed participants. Bates et al. (1999) found that depressed participants who were given negative automatic thought statements became more and more depressed
This research supports the view that negative thinking leads to depression, although this link does not mean that negative thoughts cause depression. Instead, negative thinking may develop because of their depression
Explaining depression
The cognitive approach suggests that it is the client who is responsible for their disorder. This placing of emphasis on the client is a good thing because it gives the client the power to change the way things are. (Note that the cognitive approach refers to a client rather than a patient’) However, this stance has limitations. It may lead the client or therapist to overlook situational factors, for example not considering how life events or family problems may have contributed to the mental disorder
The strength of the cognitive approach therefore lies in its focus on the client’s mind and recovery, but other aspects of the client’s environment and life may also need to be considered
Explaining depression
A limitation of the cognitive approach is that not all irrational beliefs are ‘irrational, they may simply seem irrational.
In fact, Alloy and Abramson (1979) suggest that depressive realists tend to see things for what they are (with normal people tending to view the world through rose-coloured glasses). They found that depressed people gave more accurate estimates of the likelihood of a disaster than ‘normal’ controls, and called this the sadder but wiser effect
These doubts about whether irrational thinking really is irrational raise questions about the value of the cognitive approach
Treating depression
Ellis (1957) claimed a 90% success rate for REBT, taking an average of 27 sessions to complete the treatment - impressive research support for his therapy.
REBT, and CBT in general, have done well in outcome studies of depression (ie studies designed to measure the outcome of treatment). For example, a review by Cuijpers et al. (2013) of 75 studies found that CBT was superior to no treatment. However, Ellis recognised that the therapy was not always effective, and suggested that this could be because some clients did not put their revised beliefs into action (Ellis, 2001). Therapist competence also appears to explain a significant amount of the variation in CBT outcomes (Kuyken and Tsivrikos, 2009).
This suggests that REBT is effective, but other factors relating to both client and therapist may limit its effectiveness.
Treating depression
CBT appears to be more suitable for some individuals than others.
For example, CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change (Elkin et al., 1985). CBT also appears to be less suitable in situations where high levels of stress in the individual reflect realistic stressors in the person’s life that therapy cannot resolve (Simons et al., 1995). Ellis also explained a possible lack of success in terms of suitability - some people simply do not want the direct sort of advice that CBT practitioners tend to dispense; they prefer to share their worries with a therapist without getting involved in the cognitive effort associated with recovery (Ellis, 2001).A limitation of CBT, therefore, is the fact that individual differences affect its effectiveness
Treating depression
The belief that changing behaviour can go some way to alleviating depression is supported by a study on the beneficial effects of exercise.
Babyak et al. (2000) studied 156 adult volunteers diagnosed with major depressive disorder. They were randomly assigned to a four-month course of aerobic exercise, drug treatment (an antidepressant drug) or a combination of the two. Clients in all three groups exhibited significant improvement at the end of the four months. Six months after the end of the study, those in the exercise group had significantly lower relapse rates than those in the medication group.
This shows that a change in behaviour (i.e. physical activity) can indeed be beneficial in treating depression.
Explanation OCD
Evidence for the genetic basis of OCD comes from studies of first-degree relatives (parents or siblings) and twin studies.
Nestadt et al. (2000) identified 80 patients with OCD and 343 of their first-degree relatives and compared them with 73 control patients without mental illness and 300 of their relatives. They found that people with a first-degree relative with OCD had a five-times greater risk of having the illness themselves at some time in their lives, compared to the general population. A meta-analysis of 14 twin studies of OCD found that, on average, identical (monozygotic, MZ) twins were more than twice as likely to develop OCD if their co-twin had the disorder than was the case for non- identical (dizygotic, DZ) twins (Billett et al., 1998).
This evidence points to a clear genetic basis for OCD, but the fact that the concordance rates are never 100% means that environmental factors must play a role too (the diathesis- stress model).
Explanation OCD
The mapping of the human genome has led to the hope that specific genes could be linked to particular mental and physical disorders.
For example, it might be that where one or the other parent-to-be has the COMT gene, the mother’s fertilised eggs could be screened, thus giving the parents the choice of whether to abort those eggs with the gene. Alternatively gene therapy may produce a means of turning certain genes ‘off’ so that a disorder is not expressed. Both raise important ethical issues, not least that the same genes may have other benefits. Furthermore this presumes that there is a relatively simple relationship between a disorder, such as OCD, and genes, which may well not be the case. Applying biological therapies (such as gene therapy) is therefore more complex and controversial than it may at first glance.
Explanation OCD
The biological approach faces song competition from psychological explanations. The two-process model can be applied to OCD. Initial learning occurs when a neutral stimulus (such as dirt) is associated with anxiety. This association is maintained because the anxiety-provoking stimulus is avoided. Thus an obsession is formed and then a link is learned with compulsive behaviours (such as hand-washing) that appear to reduce the anxiety. Such explanations are supported by the success of a treatment for OCD called exposure and response prevention (ERP) which is fairly similar to systematic desensitisation. Patients have to experience their feared stimulus and at the same time are prevented from performing their compulsive behaviour. Studies have reported high success rates, for example Albucher et al. (1998) report that between 60 and 90% of adults with OCD have improved considerably using ERP.
This suggests that OCD may have psychological causes as well as, or instead of, biological causes.
Treating OCD
There is considerable evidence for the effectiveness of drug treatments. Typically a randomised control trial is used to compare the effectiveness of the drug versus a placebo (a substance that has no pharmacological value but controls for the belief that the pill you are taking will affect you). Soomro et al (2008) reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective than placebos in reducing the symptoms of OCD up to three months after treatment. One of the issues regarding the evaluation of treatment is that most studies are only of three to four months duration (Koran et al, 2007). Therefore, while drug treatments have been shown to be effective in the short term, the lack of long-term data is a limitation
Treating OCD
All drugs have side effects, some more severe than others. For example, nausea, headache and insomnia are common side effects of SSRIs (Soomro et al., 2008). Although not necessarily severe, they are often enough to make a patient stop taking the drug. Tricyclic antidepressants tend to have more side effects (such as hallucinations and irregular heartbeat) than SSRIs and so are only used in cases where SSRIs are not effective. The possible side effects of BZs include increased aggressiveness and long-term impairment of memory. There are also problems with addiction, so the recommendation is that BZ use should be limited to a maximum of four weeks (Ashton, 1997).
These side effects, and the possibility of addiction, therefore limit the usefulness of drugs as treatments for OCD.
Treating OCD
An issue with drug treatments is that they are not a lasting cure for people with OCD.Maina et al. (2001) found that patients relapse within a few weeks if medication is stopped. Koran et al. (2007), in a comprehensive review of treatments for OCD sponsored by the American Psychiatric Association (APA), suggested that, although drug therapy may be more commonly used, psychotherapies such as CBT should be tried first.
This suggests that, while drug therapy may require little effort and also may be relatively effective in the short term, it does not provide a lasting cure.
