Psycopathology Flashcards
What are the definitions of abnormality
Deviation from social norms
Failure to function adequately
Statistical infrequency
Deviation from ideal mental health
What does it mean to deviate from social norms?
Norms of behaviour are created by society
Norms represent what is acceptable ways of behaving - norms are like the rules
Deviating from these norms may be considered abnormal
Implicit and explicit
What is an example of deviating from social norms
Laughing at a funeral
Exposing yourself in public
What are implicit social norms
Unspoken
What are explicit social norms
Norms enforced by the law
What are the weaknesses of deviating from social norms
May be a lifestyle and not a choice
E.g being a vegan living in a commune
Some behaviour may be labelled abnormal in one culture but seen as a norm in another
Social norms change over time and place
Only recent years it’s been regarded as normal for homosexual relationships
In past year these individuals whete thought of as socially deviant and mentally ill
Definition is not a reliable permanent way of defining abnormality
Hearing ancestors voice in your head is considered normal in Africa but not regarded as normal in Britain
Not a universal explanation
What is meant by failure to function adequately
Being unable to manage tasks necessary in everyday life.
A person unable to deal with these tasks are considered abnormal
Only abnormal if distress is caused to self or others for example someone who is very happy not washinf their jeans is not seen as abnormal
Who conducted research into failing to function adequately as a definition of abnormality
Rosenhan and Seligman
What did Rosenhan and Selighan suggest where the 6 features of abnormality
Personal distress
Maladaptive behaviour
Unpredictability
Observe discomfort
Violation of moral and ideal standards
Irrational
What are weaknesses of failure to function adequately as a definition of abnormality
Does not account individual circumstances such as loosing a loved one where it is normal to fail to function.
Weakness because their behaviour could be identified as abnormal by this definition but would be entirely normal response to difficult circumstances.
It is not clear how extreme the behaviour has to be to be considered abnormal, how much we need to fail
What is a strength of failure to function adequately being used as a definition for abnormality
It has practical applications
Clinicians use definition when judging need for treatment
Individuals complete a questionnaire designed by WHODA which provides objective and quantitative
measurement of functioning.
Strength as definition is useful in everyday practice - easier to identify abnormality - quicker individuals can access treatment
Describe statistical infrequency as a definition of abnormality
Behaviour that is statistically infrequent or very rare is regarded as abnormal
descriptive statistics describe typical values, what is most common - normal
A frequency graph of behaviours shows a normal distribution
Most people are in the central groups or clustered to the mean
The extreme ends define abnormal behaviour
What is an example of statistical infrequency
Intelligence measured by an IQ test is normally distribute. Most people range from 85 to 115. Only 2% have a score below 70.
This is very unusual so would be considered abnormal
What are weaknesses of using statistical infrequency to define abnormal behaviour
Does not account for desirability, some behaviour may be describe abnormal but is desired for example having an IQ over 150.
Weakness as does not distinguish between desirable and undesirable behaviours - does not help us to identify behaviours in need of treatment.
Some abnormal behaviour is not rare. Depression and anxiety are quite common. 37% teenage girls reported low mood. This would not be identified as abnormal according to this definition but people with anxiety and depression still need help. Weakness as definition cannot appropriately identify more common health conditions as abnormal.
The cut off point between normal and abnormal is subjective. We might decide the abnormal amount of sleep is sleeping over 9 hours a day but some could argue over 10 hours would be a better cut off point.
Weakness as different people will judge the same behaviour differently
What is a strength of using statistical infrequency as a definition for abnormality
It has real life applications
Assessments of patients with mental illnesses include some kind of measurement of their symptoms compared to statistical norms
This is a strength because statistically deviation is a useful part of clinical assessments of patients
Reflects the objective nature of this definition
What is meant by deviation from ideal mental health
Jahoda identified six characteristics of ideal mental health.
Said to be characteristics that enable individuals to behave appropriately and competently and lead a happy life.
Any individual who does not possess all of these characteristics would be regarded as abnormal
- positive self attitudes
- self actualisation
- resistance to stress
- autonomy
- having an accurate perception of reality
- mastery of the environment
What does it mean to have positive self attitudes
High self esteem and strong sense of identity
What does it mean to have self actualisation
Motivated to develop and reach full potential
What does it mean to be resistant to stress
Ability to cope with stressful situations
What does it mean to have autonomy
Being independent and self - resilient
What does it mean to have mastery of the environment
The ability to love, work, have personal relationships and adapt to new situations
What are the weaknesses of deviating from ideal mental health
Most people would be considered abnormal as it represents idealised set of expectations.
Very few people have all 6 characteristics.
Definition suggests many of us and mentally unhealthy and abnormal.
This is a weakness as abnormal behaviour is considered to be unusual rather than that shown by the majority of people - this means the definition may not be useful in identifying abnormal behaviour
Weakness is the inclusion of self actualisation as a criteria for mental health.
Culturally biased as based on western ideas of self fulfilment. Assuming self actualisation is universal and achievable.
In some cultures self actualisation is abnormal where the true potential is being indicative of selfishness.
Very few people achieve self actualisation - if this is the criteria most of us would be defined as mentally unhealthy
A strength of deviation from ideal mental health
Offers a positive approach to identifying mental illness.
Focuses on the positive desires rather than negative undesires.
Strength as it may be a more ethical way of approaching mental health.
What is a phobia
An extreme and irrational fear of a specific stimulus that produces a conscious avoidance of the source of fear
What are behavioural characteristics of a phobia
Avoidance
Fainting/freezing
What are emotional characteristics of phobias
Excessive unreasonable fear anxiety and panic
What are cognitive characteristics of phobias
Recognition of the irrational nature of their fear
Can not help phobia by rational argument
How does the behavioural approach explain phobias
All phobias are learnt through the two process model
Explain the two process model
Step 1 - phobia develops through classical conditioning ( learning through association)
Involves an individual associating two stimuli with one another when they occur at the same time.
Association forms means individual response to one stimuli transfers to the other
Step 2 - phobia is maintained through operant conditioning
Learning through consequences
If behaviour followed by a reward behaviour is likely to be repeated
Give an example of the two process model
Step 1 - individual chokes in water may associate choking with water.
Their response to choking might transfer to eater
In future will respond to water with fear (phobia)
Step 2 - individual avoidant of water, feels rewarded as no fear, likely to continue avoiding water
Negative reinforcement
Strength of behavioural approach explaining phobias
Evidence from studies supports idea learning can be responsible for development of phobias.
Little Albert introduced to white rat, everytime he played with it, a loud noise was made. Albert developed a phobia of rats and anythinf fury.
Phobia was a conditioned learnt response
Strength because we can be more confident the behavioural approach offers an accurate explanation for how and why phobias develop.
________
Practical applications.
Successful behavioural therapy’s
Systematic desensitisation
Flooding
Research has shown effective at treating phobias
Strong positive impact upon economy allowing people to stay in work whilst undergoing treatment and minimising sick pay mddddd
Strength as behavioural approach offers solution to a problem and helps people in real world.
Weaknesses of behavioural approach explaining behaviour
Not all evidence supports claims made.
Not all phobias appear after a bad experience.
Someone may have developed fear of snakes without ever being near a snake.
Munjack found only 50% of people with driving phobia had frightening car experiences.
Weakness because instances cannot be explained through conditioning - behavioural approach can not explain all phobias
What is systematic desensitisation
Gradual exposure to feared stimulus or situation
Based on counterconditioning
Therapy is based on notion of reciprocal inhibition
This is the notion that we cannot experience two incompatible emotional states at the same time
E.g we can not be frightened and relaxed at the same time
What is counterconditioning
Learning a new association to a stimulus
New response (relaxation)
Old response (fear & anxiety)
What is the notion of reciprocal inhibition
The notion that we cannot experience two incompatible emotional states at the same time
Explain the process of systematic desensitisation
- relaxation techniques taught and practiced by individual to successfully get into a state of calm relaxation
Client focuses on feelings of relaxation after tightened muscles are released - individual creates hierarchy of fear ( list of situations or scenarios involving feared stimulus) ranked from least to most frightening
E.g thinking of a spider - 10
Let a spider crawl on your arm - 100 - individual uses relaxation techniques whilst being gradually exposed to each scenario of their hierarchy
Due to reciprocal inhibition individual learns new association between feared stimulus and feeling relaxed (counterconditioning)
Strengths of systematic desensitisation
Evidence suggests it’s effective at alleviating phobic symptoms.
Gilory compared 42 spider phobic patients treated with three, 45 minute sessions with a control group treated with relaxation alone.
Both 3 months and 33 months after treatment, experimental group showed less fearful responses than relaxation group.
Shows SD is relatively quick and long lasting therapy.
Strength because it shows SD is an effective treatment for phobias - supports work & the economy
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More ethical than flooding.
E.g SD easier to stop and less traumatic then flooding
Client has some control over the process in drawing up the hierarchy and stopping a stage when the feeling of fear becomes overwhelming.
Strength because may limit the drop out rate of therapy and can be more desirable to people seeking help
Weaknesses of systematic desensitisation
Not always an appropriate method of treatment
Someone who has an irrational fear of zombies - it would not be possible to confront actual examples of this feared stimulus.
Only option would be to use less effective vitro therapy. It may also be argued some phobias haven’t been learnt and therefore counterconditioning would also not be appropriate
This is a weakness because the therapy will not be successful for all individuals with a phobia
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Explain flooding
Based on counterconditioning and reciprocal inhibition
Involves full immediate exposure to individuals feared stimulus
What is the process of flooding
One long session (2-3 hours) where exposed to phobia at its worst whilst simultaneously using relaxation techniques.
Can take place in vitro or Vivo
Virtual reality can be used
Eventually anxiety levels come down and new association is learnt between phobic stimulus and relaxation
A strength of flooding
Research has found it is effective
Choy et al found for those who are able to see the therapy through to the end and complete session, flooding is more effective than SD
Kaplin found 65% patients with a phobia given a single session of flooding showed no symptoms 4 years later.
Strength because therapy is also quicker than SD and could be good option for many suffers of phobias ( especially with little time)
Weaknesses of flooding
Not always appropriate
Therapy deliberately creates high levels anxiety - traumatic experience for patient
If patient drops out they have negatively reinforced phobia again and may fear stimulus even more.
For many even ifea of flooding is too much.
For those who opt for therapy many will withdraw during treatment and won’t benefit from it in same way
Weakness because therapy will not be successful for all individuals with a phobia and may leave them feeling more traumatised
Define depression
A mood disorder that causes a persistent feeling of sadness and loss of interest
What are symptoms of depression
Vary but
- feeling sad
- feeling hopeless
- loosing interest in activities once enjoyed
What are behavioural characteristics of depression
- reduced energy and tiredness
- may sleep more than usual
- appetite may be reduced or increased
- irritable
What are emotional characteristics of depression
Sadness
Feeling worthless
Anger
What are cognitive characteristics of depression
Irrational negative thoughts
Poor levels of concentration
Poor desicion making
How does the cognitive approach explain depression
irrational thoughts and beliefs are the cause of abnormality.
Irrationally negative thinking is suggested cause of depression
Ellie’s ABC model + Beck’s negative triad
Explain Ellie’s ABC model
Used to explain how irrational thinking affects our emotional state and behaviour
A = activating event
B = belief system
C = consequential emotion
E.g if an individual fails an important exam (A - activating event)
but believed they must always succeed and this is a major disaster (B - belief system)
This will lead to them feeling badly about themselves (C - consequential emotions)
An irrational belief system lies in thoughts that are focused as ‘should’ and ‘must’ and are associated with not reaching perfection
What do the letters stand for in Ellie’s abc model
Activating event
Belief system
Consequential emotion
What is Beck’s negative triad
Beck suggested depressed individuals have biased thoughts towards negative interpretations of their lives and feel they have no control.
Person develops negative view of live because of 3 types of negative thinking
The negative triad
This triad refers to pessimistic and irrational view of three elements of a persons belief system
- negative view of the world
- negative view of the future
- negative view of oneself
Beck suggested this comes from negative schemas as depressed people adopt these
A schema is a package of ideas and information about a particular thing developed through our experiences
In childhood negative schemas develop providing a negative framework for viewing events pessimistically.
In adulthood these become biased such as overgeneralisation
E.g if someone fails one psychology test responding
‘I will never be able to do psychology’
What are the three key elements in a persons belief system - Becks’s triad
Negative view about the world
Negative view about the future
Negative view about ownself
What are the strengths of cognitive approach explaining depression
Important practical application
CBT = successful therapy
CBT = attempts to correct irrational negative thoughts and replace with positive rational thoughts
Strength as it’s an effective therapy for depression so supports idea that irrationally negative thinking is the cause of this disorder
Supporting evidence
Grazioli and Terry assessed preggers women for cognitive vulnerability and depression before and after giving birth
Found women judged to be high in cog vulnerability were significantly more likely to suffer post natal depression
Supports cog approach as demonstrates link between distortions in thinking and depression
Who conducted supporting research for the cognitive approach of explaining depression
Grazioli and Terry
What are weaknesses of the cognitive approach explaining depression
Cannot explain all of depression.
Symptoms of bipolar depression include mania, major depressive disorder is often associated with anger.
Cognitive approach cannot effectively explain links with mania and anger. Only focuses of explaining down moods.
Not clear if irrationally negative thinking is cause of depression or result of depressive behaviour
E.g depressed person may not have had negative thoughts before being depressed.
Weakness as cog approach is not giving full explanation of depression.
Limited explanation
Does not account for biological evidence
Low levels of serotonin
Does not account for environmental factors
Those living in inner cities more likely to suffer
More likely several factors will be cause of depression, thoughts just a contributing factor.
Weakness because means cannot offer complete explanation
What are the aims of CBT
To treat depression by altering irrationally negative thoughts
Helps individual have more rational positive thoughts - helping to improve emotions - therefore helping to improve behaviour
What are the 4 techniques of CBT
Thought Catching
Disputing
Role Play
Behavioural Activation
Explain CBT thought catching
Stage 1: identify irrational thoughts through an assessment and verbal discussion to clarify patients problems and patterns - identify goals and a plan
Patient may be given homework to apply rational thoughts to real life settings or told to keep a thought diary to identify negative thinking (based of beck’s triad)
Stage 2: Ellie’s ABC model used but extended to ABCDEF
D = disputing irrational thoughts and beliefs
E = effects of disputing the thoughts
F = new feelings produced
Therapist helps patient to think rationally
CBT what is ABCDEF
A = activating event
B = Belief system
C= Consequential Emotion
D = disputing irrational thoughts
E = effects of disputing the thoughts
F = new feelings produced
Explain CBT technique disputing
1) consider whether there is any evidence for their thoughts and beliefs in a process of empirical disputing - E.g do you have any examples of times when you have suffered bad luck
2) whether they are useful beliefs in pragmatic disputing - E.g does considering yourself an unlucky person help you in anyway
3) whether they are sensible ways to think in logical disputing - E.g is it reasonable to think that your life is particularly unfair
Effective disputing allows the person to move from catastrophising to more rational interpretations of events.
This in turn helps them to feel better and become more self accepting
What are the names of the 3 disputing techniques
Empirical Disputing
Pragmatic Disputing
Logical Disputing
Explain CBT technique role play
Therapist role plays situation during therapy session to help person challenge their typical ways of thinking and practice replacing irrational thoughts with rational
Explain CBT behavioural activation
Identify mood triggers, what activities make us feel happy or sad - encourage client to engage in behaviours that ‘lift’ mood
Strengths of CBT
Shown to be effective
One study compared 327 adolescents between 12-17 suffering major depression.
Effects of CBT compared with drug therapy.
80% of patients responded well to CBT - showing it’s effective
Smith and Glass also conducted a meta- analysis of therapies and found CBT was second highest
Strength because CBT may be a better option than drug therapy
Weaknesses of CBT
Weakness opposing effectiveness
May be down to quality and competence of therapist.
Research shown as much as 15% variance of outcome may be attributed by therapist: competence.
Weakness because depending on therapist, CBT may help some individuals but be less successful for others.
Ignores individual circumstance
Ignores patients living in poverty
Therapy focuses on what’s happening in the mind
Therapy fails to appreciate impact of persons environment and significance of activating events
Weakness as CBT might demotivate people to change their situation and address the real cause of the problem
What is OCD
Obsessive -cumpolsive disorder
Define OCD
A mental health condition where a person has obsessive thoughts and compulsive activity. The thoughts and rituals associated with OCD cause distress and grt in the way of daily life as they cannot be controlled
What are behavioural characteristics of OCD
Repetitive behaviour - compulsions
Avoidance of anxiety triggering situations
What are emotional characteristics of OCD
Anxiety and distress by obsessive and compulsive thoughts
Shame and embarrassment over excessive nature of behaviour
What are cognitive characteristics of OCD
Recurrent, intrusive and uncontrollable thoughts
Irrational and distorted beliefs
Obsessions
How does the biological approach explain OCD
Biological assumes abnormal behaviour of OCD caused by problems with the body and brain.
Believes mental illness has a physical cause due to genes, neurons stony and neurotransmitters
What physical factors does the biological approach state cause OCD
Genes
Neurotransmitters
Neuroanatomy
Explain the biological genetic explanation of OCD
OCD can be passed from parent to child through genetic inheritance.
Geneticists have identified 2 genes which may be implicated for vulnerability for OCD
COMT GENE
SERT GENE
What are the two genes linked to OCD
COMT
SERT
Explain the COMT gene in relation to OCD
COMT involved in production of enzyme COMT which regulates production of dopamine.
One form of COMT lowers activity of the enzyme and therefore higher levels of dopamine
This is commonly found with individuals with OCD
Explain the SERT gene linked to OCD
Involved in production of a protein that removes serotonin from synapse between neurons.
Mutation of this gene leads to higher activity of protein and low levels of serotonin.
Mutation is often found in families where many members have OCD
Evaluate genetic arguments of OCD
Supporting research.
Nestadt reviewed twin studies and found 68% identical twins showed concordance rate for OCD compared to 31% in non - identical twins.
Strongly suggests genetic element to OCD.
Strength as gives us confidence genes may cause OCD, better chance of medecine
Weakness - difficult to draw conclusions about influence of genes alone
Twins generally exposed to same environmental factors and the higher MZ concordance rates could be explained by identical twins being treated more similar and so sharing similar behaviours.
No studies show 100% concordance rate of MZ twins, suggesting other factors must be involved.
This shows nature and nurture together,, suggesting genetic factors predispose an individual developing OCD but environmental factors trigger the disorder
Who found supporting research for genetic arguments of OCD
Nestadt
What are neural explanations of OCD
Genes associated with OCD likely to affect neurotransmitters as well as brain structure.
Neural explanations say OCD caused by abnormal levels of neurotransmitters such as serotonin and certain structures within the brain that make up the worry circuit
Explain serotonin is a neural explanation for OCD
OCD may be caused by disruption of serotonin which have a knock on effect regulating other levels of neurotransmitters such as GABA and dopamine.
Idea is based on drug therapy evidence which indicates reduction in symptoms of OCD seen in individuals who take anti depressant drugs that increase serotonin activity.
It is argued low serotonin is responsible for OCD symptoms
Explain the neuroanatomy worry circuit of OCD
Symptoms of OCD arise from structural damage to brain.
Argued their are impairments in an area of the brain termed the basal ganglia - specifically in this region an area termed the caudate nucleus.
Three areas in the worry circuit:
The orbits frontal cortex OFC
The caudate nucleus
The thalamus
The OFC sends ‘worry’ signal to thalamus when we are anxious.
These signals usually suppressed by caudate nucleus.
If damaged caudate nucleus fails to block signal and thalamus is alerted
Thalamus sends signal back to OFC, creating a circuit.
Typically OFC regulates the transmission of information regarding worrying events between the thalamus and the OFC but in OCD the orbits frontal cortex is over active and therefore incorrectly regulates worrying information.
This makes it difficult for individual with OCD to pay attention to anything other than worrying and to plan behaviours other than compulsions
What are the three areas involved in the worry circuit
Orbits frontal cortex (OFC)
Caudate nucleus - part of basal ganglia
Thalamus
Evaluate neural explanations of OCD
Supporting research for role of serotonin in OCD
evidence based on drug therapy supports notion serotonin plays role in OCD
Zohar et al found drugs increase serotonin beneficial up to 60% of patients with OCD
Supports idea low serotonin associated with OCD - and thus it might comorbid with depression
Weakness is inconsistent findings from research studies - neuroimaging studies have not identified basal ganglia impairments in all OCD suffers and some people with impairments in the basal ganglia shows no sigh of OCD.
Twin and family studies not all found same concordance rates
Difficult to draw firm conclusions about role of biology in OCD
What are two general weaknesses of biological approach of explaining OCD
Difficult to determine cause and effect
Not sure if neural abnormalities are causes or results - explanation may not fully explain what set out to
Heavily focused on nature - reductionist
Explanation looks at physical causes for OCD and ignores impact of experiences - ignores life experiences
Explain drug therapy as a way of the biological approach treating OCD
Drugs - easy accessible treatment to rebalance neurotransmitters in the brain.
There are a number of different types of drugs that can be prescribed as a treatment of OCD
Selective serotonin reputable inhibitors SSRI’s eg prozac
Benzodiazepines anti anxiety drugs eg Valium
What are the names of drugs used to treat OCD
Benzodiazepines
Selective serotonin reuptsake inhibitors
Explain selective serotonin reputake inhibitors
Work by increasing serotonin levels that pass around the brain.
Raising serotonin helps to reduce the symptoms of OCD in those suffering with the disorder
Drugs act by preventing serotonin flows from one neuron to the next from being re absorbed or removed from the system, leaving greater amounts of serotonin in the synapse, continuing to stimulate the post synaptic nerve
Explain benzodiazepines
Anti anxiety drugs control brain activity and bring feelings of calmness
BZ’s act on chemicals within the brain and slow down activity within the CNS
BZ’s enhance GABA - the body’s natural anxiety relief.
GABA Is an inhibitory neurotransmitter (calming effect on brain neurons)
During synaptic transmission GABA binds with GABA A receptors on post synaptic neuron. This opens a channel which increases flow of chloride ions to post synaptic neurons, making it more difficult for post synaptic neuron to be stimulated by other neurotransmitters. Less likely to be passed on
As neuron is less responsive to excitatory neurotransmitters, reduces neuron activity in brain
What is an example of SSRI’s
Prozac
What is an example of BZ’s
Valium
Evaluate drug therapy of treating OCD
Evidence for effectiveness for drugs to treat OCD
Soomro conducted a meta analysis of 17 studies of OCD patients treated with SSRI’s found all 17 studies SSRI’s more effective than a placebo
BZ’s also more affective than placebo.
Show there is an actual therapeutic process taking place in altering brain chemistry.
This means BZ’s are an effective treatment for anxiety conditions such as OCD
Weakness of drug therapies is that they do not cure OCD
Reduce symptoms of the illness but once person stops taking, symptoms return.
Underlying problem - cause of compulsions has not been dealt with. Psychological therapies aim to cure mental illness by addressing root cause of the conditions.
This is a weakness because a better form of treatment for OCD might be to combine drug treatment and psychological therapy to maximise the benefit to the patient. Drug therapy alone is not effective enough
Weakness - not all evidence supports effectiveness of drug therapies. Zohar found only 60% of clients improved with drugs that increase serotonin. Suggests there are individual differences in how people respond to drug therapy and might also cast doubt upon the biological explanation of OCD
Evaluate the appropriateness of drug therapy of OCD
Weakness of drug therapies - they do not cure OCD. They reduce the symptoms of the illness but when person stops taking drugs, symptoms of OCD return. This means the underlying problem has not been dealt with. Psychological therapies sim to cure mental illness by addressing the root of the condition. This is a weakness because a better form of treatment might be to combine drug treatment and psychological therapy to maximise the benefit to the patient, drug therapy alone is not effective enough.
A strength of this type of therapy is that drugs are relatively fast and require little effort by the individual whereas drug therapies require virtually no input in terms of time or motivation. This is a strength because the therapy may be appropriate for people with OCD who lack insight into their thought processes and emotions or who cannot commit time to therapies.
Weakness- negative side effects of taking drugs, eg nausea, headaches and insomnia often reported by people taking SSRI’s and possible effects of BZ’s include aggression and long term memory impairment. BZ’s also linked to dependency and can not be taken for a long time. Weakness as although they are effective treatment some people with OCD prefer not to take medication and therefore drugs are not appropriate for all as a treatment, relapse rates are also as high as 90% which shows drugs is not a permanent cure for the disorder as soon as the treatment stops, symptoms return.
