Pyschopathology Flashcards
Define pathology
Means the study of the causes of disease
How can we define abnormality in a fully objective way
It must not depend on anyone’s opinion or point of view.
It should produce the same results whoever applies it.
It must not be under- or over-inclusive.
It must not label as ‘abnormal’ or ‘normal’ behaviours or traits that are not.
Explain why labelling a behaviour or a person as abnormal has consequences:
Defining a person or behaviour as ‘abnormal’ implies something undesirable and requiring change.
Therefore, we must be careful how we use the term. Psychologists need methods for distinguishing ‘normal’ from ‘abnormal’.
Define statistical infrequency
Someone is mentally abnormal if their mental condition is very rare in population, the rarity of the behaviour is judged objectively using statistics, comparing the individual’s behaviour to the rest of the population.
How can we find statistical infrequency
A normal distribution curry shows a population’s average spread of specific characteristics. The mean, median and modal scores are all at the highest point, the most common behaviour. At each end there are fewer people with those behaviour. If we wan to find abnormal behaviour, we can compare the individuals to the population and identity those at the extreme end.
Evaluate statistical infrequency
Positive:
A positive for using statistical infrequency to define abnormality is those individuals who are assessed as being abnormal have been evaluated objectively; other definition depends on subjective opinion.
It is an obvious and relatively quick and easy way to define abnormality (using psychometric tests developed using statistical methods we can compare the psychometric measurement of their symptoms to the norm)
Negative:
**A criticism of statistical influence is the psychological community decides the cutoff point for what is statically rare enough to be defined as abnormal; this is a subjective decision with real implications. **
Not all statistically rare traits are negative traits. ( a good definition of abnormality should not identify people with a very high IQ as having psychopathology and in need of additional support)
High range of common psychopathology, such as depression and anxiety. This definition isn’t appropriate when considering societies high incidence of mental health disorder
Someone may not benefit from being labeled ‘abnormal’. May cause more harm than good
Cultural and historical relativism- what is statistically frequent and acceptable in one culture or time period may not be the norm in another (Marijuana smoking in Jamaica)
Define failure to function adequately
The individual is defined as abnormal if they cannot cope in their daily lives ,including their ability to interact with the world and meet their challenges.
Explain Rosengham and Seligma (1989) features of failure to function adequately:
Maladaptive behaviour: Individuals behave in ways that go against their long-term interests
Personal anguish: The individuals suffers from anxiety and stress
Observer discomfort: The individuals behaviour causes distress to those around them
Irrationality: It is difficult to understand the motivation behind the individuals/unpredictability: unexpected behaviour
Unconventionality: Behaviour doesn’t match what is typically expected to society.
Evaluate Failure to function adequately
Positive:
FFA respects the individuals and their own personal experience, which is something other definitions, such as statistical infrequency and deviation from social norms cannot do, as these definitions of abnormality are based on the rest of the population
Negative:
The decision about whether someone is coping is subjective and based on the clinician’s opinion. (Judgement may be biased two observers may not agree whether someone is managing)
FFA only includes people who cannot cope: people with antisocial personality disorders can often function in society in ways that benefit them personally.( Having low empathy may lead to success in business and political, however, while people don’t have distress themselves , psychopathy can have negative impacts on people around them)
Not all maladaptive behaviour indicates mental illness. (Extreme sports, eating unhealthy, drinking alcohol all risk an individuals health therefore maladaptive. However, most people would disagree that these activities indicate mental illness.
A label can give a stigma that can stick for a long time after a problem is gone and may affect peoples lives. (Relationships or employment)
Define deviation from social norm
A social norm is an unwritten expectation of behaviour that can vary from cultures to culture and change over time. Additionally, what it accepted in one context may not be acceptable in another , and people who deviate from these societal expectation may be seen as abnormal or social deviants.
Example of societal norms that vary between culture to culture
Acceptance of homosexuality
Face and hair covering
Acceptable food and how we eat it
Modesty of clothing choice
Display of emotion in public
Evaluate deviation from social norm
Positive:
It does not impose a western view of abnormality on other non-western cultures. (It is argued diagnosing abnormality according to social norms is not ethnocentric: it respects the cultural difference in societies.
Real life application for diagnosis e.g antisocial personality disorder
Negative:
It can be inappropriate to define people who move to a new culture as abnormal according to the new cultural norms. (E.g- people from Afro-Caribbean background living in the UK are 7 more time likely to be diagnosed schizophrenia as Western cultures define mental illness as individuals who do not follow their cultural norms, whereas in the Caribbean their behaviour would be accepted)
It can be seen as punishing people who are trying to express their individuality and repressing people who do not conform to the repressive norms of their culture. (e.g World Health Organisation declassified homosexuality as a mental illness ; these changes may have followed social norms.
Social norms is a subjective measurement of abnormality as norms change over time and differs between cultures. For example cultural such as in Japan- you were deemed insane if you do not want to work and historical issues seen in 1967 UK where homosexual acts were criminal offenses
Define deviation from ideal mental health
(Jahoda 1958) -Focuses on ways to improve and become a better person rather than dysfunction or deficit. It identifies six features of ideal mental health and argues deviation from these features indicates abnormality
Wha are six features which indicate abnormality
Environmental mastery: the ability to to adapt and thrive in a new situation
Autonomy: The ability to act independently and trust in one’s own ability
Resistance to stress: The internal strength to cope with anxiety caused by daily life
Self-actualisation: The ability to reach one’s potential though personal growth
Positive attitude towards oneself: Characterised by high self self-esteem and self-respect
Accurate perception of reality: The ability to see the world as it is without being distorted by personal biases.
Evaluate deviation from ideal mental health
Positive:
This definition is a more constructive and holistic approach to mental health than other definitions. DIMH considers multiple factors in diagnosis and provides suggestion for personal development.Additionally, DIMH does not simply state what is wrong but also suggest how problems can be overcome.
The definition respects the indicates and their own experiences.
Negative:
The definition of deviation from social norms comes from its basis in humanistic psychology, which may be culturally biased, reflecting a Western perspective on mental health (emic construct). This is problematic as one culture e.g an individualistic Western culture is assumed to to apply to all people universally. This problem is known as an imposed etic . Other countries may not have the same individualistic Western view and focus more on community (collectivist societies)
The strictness of the criteria defining mental health. Most people would be defined as abnormal, according to DIMH,as it is difficult to achieve all of the criteria for ideal meant health at any one time.
What are the four definitions of abnormality
Statistical infrequency / deviation from statistical norms
Deviation from social norms
Failure to function adequately
Deviation from ideal mental health
Explain deviation from social norms
Society sets up rules for behaviour based
on a set of moral standards which become
social norms. Any deviation is seen as
abnormal (Szasz, 1972). When a person
behaves in a way which is different from
what we expect.
Define phobia
An extreme or irrational fear of objects (specific phobias), or when it comes to social phobias, to some situations. E.g arachnophobia / claustrophobia
Explain behavioural characteristics to a phobia
Avoidance- physically adapting normal behaviour to avoid phobic objects (e.g-crossing the street
Panic- An uncontrollable physical response, and its most likely to happen at the sudden appearance of the phobic objects. (E.g-screaming and hyperventilating)
Failure to function- Difficulty to take part in activities required to reform a normal life. (e.g-going to work/ education or events)
Explain emotional characteristics to a phobia
Anxiety- An uncomfortably high and persistent state of arousal,making it difficult to relax. Heightened anxiety when the individuals is likely to encounter the phobia.
Fear: An intense emotional state linked to the flight or fight response, a sensation of extreme and unpleasant alertness in the presence of the phobia that only subsides when the phobic object is removed.
Explain cognitive characteristics to a phobia
Irrational thoughts (fear): negative and irrational mental processes that include an exaggerated belief in the harm the phobic objects could cause them
Reduced cognitive capacity: People with a phobia cannot concentrate on day-to-day activities such as work due to the excessive attentional focus on the phobic objects and constant concerns about potential of danger they feel they are in.
Define depression
A mood disorder defined by a consistent and long lasting sense of sadness
Explain behavioural characteristics of depression
Reduction in activity level: Includes lethargy, lacking the energy needed to perform everyday activities (e.g. personal hygiene/washing). Anhedonia is the lack of pleasure usually felt doing enjoyable activities, leading to a reduction in social behaviour.
A change in eating behaviour: Often results in either significant weight gain or weight loss.
An increase in aggression: This can be towards other people, but these aggressive acts often take the form of self-harm.
Explain emotional characteristics of depression
Sadness: A persistent, very low mood
Guilt: linked to helplessness and feelings that they have no value in comparison to other people
Explain cognitive characteristics of depression
Poor concentration: People with depression cannot give their full attention to tasks, and when they need to make a decision, they can be indecisive, unable to choose between completing option
Negative schema: Automatic negative biases when thinking about themselves, the world and the future
Define OCD
Defined by obsessions, which are constant intrusive thoughts that causes high anxiety levels.Compulsions that are the behavioral response , an attempt to deal with the continuous invasive thought process.
Explain behavioural characteristics of OCD
Compulsions: behaviours performed repeatedly to reduce anxiety; however, any anxiety reduction is only temporary. e.g. checking behaviours (testing that the lights/gas is off, the door is locked).
Ritual cleaning behaviours (cleaning kitchen or hands)
Avoidance: take or resist actions to avoid being in the presence of objects/ situations that trigger obsessions.
Social impairment: not participating in enjoyable social activities. This social withdrawal is often due to difficulty leaving the house without triggering obsessions or the need to carry out compulsions becomes time-consuming.
Explain emotional characteristics of OCD
Anxiety: an uncomfortably high and persistent state of arousal, making it difficult to relax. Anxiety results from the obsession, the constant worst-case-scenario thinking that defines OCD.
Depression: A consistent and long-lasting sense of sadness. The result of being unable to control the anxiety-causing thoughts and the OCD symptoms taking over the sufferer’s life, leading to issues like social withdrawal
Explain cognitive characteristics of OCD
Obsessions: intrusive, irrational and recurrent thoughts that tend to be unpleasant catastrophic thoughts about potential dangers.
Hypervigilance: A permanent state of alertness where the sufferer is looking for the source of their obsessive thoughts; for example, someone with a contamination obsession looks at each surface they need to touch, thinking about the potential threat of exposure to germs.
Selective attention (attentional bias): This means the individual with OCD is so focused on the objects connected to the obsession they cannot focus on other things in their environment or concentrate on conversations.
DSM-V requirement for a phobia
• Marked and persistent fear of a specific object or situation
• Exposure to the phobic stimulus nearly always produces a rapid anxiety response
• Fear of the phobic object or situation is excessive
• The phobic stimulus is either avoided or responded to with great anxiety
• The phobic reactions interfere significantly with the individual’s working or social life, or he/she is very distressed about the phobia
What do all behaviourists share (psychopathology)
Behaviour (including phobic behaviour) is learned from interacting with the environment, so from experience
Explain the two process model
The two-process model (Hobart Mower-1960): Phobias are acquired through classical conditioning (learning through association). Phobias are maintained through operant conditioning (learning from consequences/reinforcement).
What process results in a phobia to be acquired
Classical conditioning
What process results in a phobia to be maintained
Operant conditioning
Explain how a phobia can be acquired through classical conditioning
A phobic object (e.g. a bee) starts as a neutral stimulus (NS), it causes a neutral response (NR), so there is no response.
An unconditioned stimulus (UCS) (e.g. pain of being stung) produces an unconditioned fear response (UCR), Unconditioned stimulus-response links are automatic; they don’t need to be learnt.
An association is formed when a neutral stimulus (NS) is paired with the unconditioned stimulus (UCS). The object (Bee) becomes a conditioned stimulus (CS), now producing the conditioned response (NR) (fear)
Phobias can be generalised, so a conditioned fear response is also experienced in the presence of stimuli that are similar to the conditioned stimulus. So fear of bees could be generalised to other small flying insects.
Explain how a phobia can be maintained through operant conditioning
Operant conditioning is a form of learning that occurs through learning the consequences of our actions.
A person with a phobia is aware of their phobia and will try to avoid the phobic object and the situations that put them in contact with it.
This avoidance behaviour leads to a reduction in anxiety, which is a pleasant sensation. This reinforcement strengthens the phobia, making the person more likely to avoid the phobic object in the future.
Evaluate the behaviourist approach to explain phobias
Positive:
Watson and Rayner (1920), when introduced to a rat for the first time, a young child called little Albert showed no phobic response. However, Watson paired the rat with hitting a large metal pole behind a child’s head, creating a loud noise and scaring the child. A phobic response formed, and the rat produced a fear response, demonstrating phobias can be acquired through association. Little Albert also showed generalisation, displaying a fear response to other similar objects such as small dogs and furry blankets.
The two process model is a step forward when it was proposed (1960)- Behaviourist theories of phobia acquisition and maintenance have been practically applied to counter-conditioning therapies, systematic desensitisation and flooding. As these treatments are effective, this suggests the behaviourist principles they are based on are valid. (Explained how phobias were maintained over time, however once a patient is prevented from avoiding their phobia, the behaviour ceases to be reinforced and it declines.)
Negative:
• The behaviourist approach does not take into account thecognitive aspect.
• The two process model explains maintenance of phobias in terms of avoidance.
Counter-research by DiNardo showed while conditioning events like “dog bites” were common in participants with dog phobias (56%), they were just as common in participants with no dog phobia (66%).
Mendes and Clark found that only two percent of children with a phobia of water could recall a negative experience of water, and 56% of parents told the researchers the phobia had been present from the child’s first encounter with water. These findings suggest the behaviourist approach does not fully explain all phobias.
Not all avoidance behaviour associated with anxiety reduction. There is evidence which shows avoidance behaviour is motivate more by positive feeling of safety. (Agoraphobia-motivating factor is choosing an action such as not leaving the house is not so much to avoid the phobic stimulus but to stick with the safety factor (Buck, 2010))
Humans also don’t often display phobic responses to objects that cause the most pain in day-to-day life, such as knives or cars. However phobias of snakes and spiders are more common. These phobias may be better explained by evolutionary theory, as these are dangers that many of our evolutionary ancestors faced-Boutnon (2007). Those with a natural, instinctual fear would have been more likely to survive and reproduce, suggesting that phobias are hereditary. (Seligman-1971 called this biological preparedness- the
innate predisposition to acquire certain fears.)
Define reciprocal inhibition
Reciprocal inhibition: fear and relaxation are two antagonistic emotions, as you can’t feel two opposite emotions simultaneously.If the therapist can help the client hold the phobic object without fear, they have been successfully counter-conditioned.
Explain the process of systematic desensitisation to treat phobias
1) therapist teaches the client relaxation techniques like breathing exercises.
2) The client creates an anxiety hierarchy, a list of feared situations with the phobic object, from the least to the most feared.
3) The client is exposed to each level of the anxiety hierarchy, starting with the least anxiety-producing level of the anxiety hierarchy. Importantly, the client must relax at each stage, and the therapist moves to the next step only when the client is fully relaxed.
4) When the client can hold the phobic object without fear, the association is extinct, and a new association with relaxation is formed.
Explain the process of flooding to treat phobias
Flooding attempts to counter condition a phobia by immediate and full exposure to the maximum level of phobic stimulus. (e.g. the top level of the previous anxiety hierarchy).
Immediate exposure is expected to cause an extreme panic response in the client (cry/scream). The therapist’s job is to stop the client from escaping the situation.
A fear response takes energy. Eventually, the client will become exhausted and calm down in the presence of the phobic object.
If the client ends the treatment before this point, anxiety will decrease due to removing the stimulus, and the phobia will have been reinforced.
What is the main idea behind how behaviourist psychologist use to treat phobias
They assume that phobias are learn through association and attempt to replace the fear association with relaxation
Evaluate the behaviourist approach to treating phobia (SD)
Positive:
Gilroy et al. (2003)- 42 patients treated for a spider phobia in three 45 minute sessions, compared to a control group who were treated by relaxation without exposure. At 3 months and 33 months the treatment group were less fearful than the relaxation group
Client controls systematic desensitisation (SD) Some people with anxiety disorders, also have learning
disabilities. It can be difficult for people to understand other therapies such as flooding or CBT that require the ability to reflect on what you are thinking. This makes CBD a more pleasurable experience to limit their anxiety.(However could lead to more sessions compared to flooding) - low refusal and attrition rates
The principles of systematic desensitisation have been applied to “virtual reality exposure therapy”, Garcia-Palacios found 83% of participants treated with VR exposure to spiders showed clinically significant improvement compared to 0% in the control group. This demonstrates the principles of SD are valid, and the use of VR allows a wider range of phobias to be treated.
Negative:
The effectiveness of both systematic desensitisation and flooding may be limited to the controlled environment of a therapist’s office and may not translate to real-world experiences. For instance, a person may successfully conquer their fear of birds in the presence of a tame bird within the therapist’s room, but when confronted with numerous wild birds in the outside world, their phobia may resurface.
Both systematic desensitization and flooding are more effective in treating specific phobias (e.g., fear of objects) than social phobias, it is generally easier to construct and gradually advance an anxiety hierarchy for object-related phobias, or undergo a complete and intense exposure to snakes within a controlled setting, than to simulate social situations and interactions with unfamiliar individuals in a therapist’s office.
Pharmacological drugs are considered an effective alternative for treating phobias. These medications reduce anxiety and alleviate phobic responses and are generally quicker and cheaper than systematic desensitisation or flooding which requires many session with a qualified therapist.
Evaluate the behaviourist approach to treating phobia (flooding)
Positive:
Due to the temporary nature of drug therapy and the potential and adverse effects, sufferers often prefer behaviour treatments and medications are typically used as a temporary measure before undergoing therapy
Flooding is at least as effective as other treatments for specific phobias.Ougrin (2011) have found that flooding is highly effective and quicker than alternatives.As it is quicker, this also makes it cheaper.
Negative:
Ethical safeguards-Flooding is an unpleasant experience so it is important that patients give fully informed consent. They should be fully prepared before the session.
Flooding may not be appropriate for older people, with heart conditions or children due to this stressful nature.
The phobias is reinforced if flooding fails and the client is released before the anxiety subsides. Time and money therefore wasted.
The effectiveness of both systematic desensitisation and flooding may be limited to the controlled environment of a therapist’s office and may not translate to real-world experiences. For instance, a person may successfully conquer their fear of birds in the presence of a tame bird within the therapist’s room, but when confronted with numerous wild birds in the outside world, their phobia may resurface.
Both systematic desensitization and flooding are more effective in treating specific phobias (e.g., fear of objects) than social phobias, it is generally easier to construct and gradually advance an anxiety hierarchy for object-related phobias, or undergo a complete and intense exposure to snakes within a controlled setting, than to simulate social situations and interactions with unfamiliar individuals in a therapist’s office.
Pharmacological drugs are considered an effective alternative for treating phobias. These medications reduce anxiety and alleviate phobic responses and are generally quicker and cheaper than systematic desensitisation or flooding which requires many session with a qualified therapist.
Symptom substitution- Common criticism for flooding and SD. One phobia disappears and another replaces it! Evidence is mixed however Freud says : “If is said to occur if the unconscious impulses and
conflicts responsible for the original symptom are not dealtwith effectively”
Explain extinction (psychopathology)
Involves immediate exposure to a frightening experience.
There is no option of avoidance and the patient quickly learns that the phobic stimulus is harmless.
Sometimes the patient may achieve relaxation in the presence of the phobic stimulus because they become exhausted by their own fear response.
Explain systematic desensitisation
• This is a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning.
• If the client can learn to relax in the presence of the phobic stimulus they will be cured.
• A new response is learnt – this is called counterconditioning.
Key ideas behind the cognitive approach to depression
Depression is due to irrational thoughts, resulting from maladaptive internal mental processes. It is the way of thinking which causes the problem than the problem itself . Mental health disorder can be overcome by learning to use more appropriate cognitions (thinking positive)
Both Beck’s CBT and Ellis’s REBT attempt to change negative schemas and challenge irrational thoughts through cognitive reconstruction.
Explain schema (psychopathology)
Mental frameworks/ expectations based on experience. Schemas allow us to quickly process large amounts of sensory information and make automatic assumptions and responses.
Negative schemas result in automatically negative cognitive biases.
Explain Becks’s ideas to why people are more cognitively vulnerable than others
Beck suggested that there is a cognitive explanation as to why some people are more vulnerable to depression than others. These are:
faulty information processing: • Beck believed that people who have depression make fundamental errors in logic. Beck proposed that people who have depression, tend to selectively attend to the negative aspects of a situation and ignore the positive aspects. There is a tendency to blow small problems out of proportion with thinking in terms of black and white and ignoring the middle ground; you are a success or a failure, rather than not good at some things but OK at other
Negative self-schema: People who have depression, have developed negative self- schemas and therefore they interpret all the information about themselves in a negative way
Negative triad: Three Schemas with a persistent automatic negative bias. They have a tendency to view themselves, the world and the future in pessimistic ways – the triad of impairments
These schemas are:
The Self:Aka self-schemas, feeling “inadequate or unworthy.”
The World: Thinking people are “hostile or threatening.”
The Future: Thinking “things will always turn out badly.”
This can lead to avoidance, social withdrawal and inaction
The negative triad develops in childhood but provides the framework for persistent biases in adulthood, leading to Cognitive distortions, perceiving the world inaccurately.
These cognitive distortions are:
Overgeneralisation: One negative experience results in an assumption that the same thing will always happen.
Selective abstraction: Mentally filtering out positive experiences and focusing on the negative
Explain Ellis’ ABC model
. Ellis suggested the ABC model. IF beliefs are subject to cognitive biases (in the same way as Beck’s) then they can cause irrational thinking which may produce undesirable behaviours.
A: Activating event. It can be anything that happens to someone. (large or small) External events during situations which cause irrational thinking. (We have depression from negative events which causes irrational thinking)
B: Belief. For people without depression beliefs about A are rational. People with depression have irrational beliefs. Some of these irrational beliefs are:
Mustabatory thinking: The consequence of not accepting we don’t live in a perfect world.
-‘I can’t-stand-it-itis’- whenever something does not go smoothly, it is a disaster
-Utopianism- life is always meant to be fair
“There are three musts that hold us back: I must do well. You must treat me well. And the world must be easy.” - Ellis.
The fact that we fail to achieve unrealistic goals other people don’t behave the way we want them to, or an unexpected event happens and ruins our plans leads to disappointment.
C: Consequence. Rational beliefs lead to positive consequences; irrational beliefs lead to negative consequences. These consequence can be emotional or behavioral
Evaluate the cognitive approach to explaining depression
Positive:
Grazioli and Terry (2000) assessed the thinking styles of 65 women before giving birth and six weeks after. It was found that those women with negative thinking styles were the most likely to develop postpartum depression, especially in women with infants who were identified as having a difficult temperament. This supports the idea that faulty thinking leads to depression, but also that there is a diathesis-stress mechanism to Beck’s theory, negative thinking is a vulnerability which can be triggered by aversive life experiences like motherhood. Therefore, depression is associated with faulty formation processing, negative self schema and the triad of impairment.
Cognitive theories that explain depression have led to highly effective cognitive therapies; March showed CBT had an effectiveness rate of 81% after 36 weeks of treatment, the same as drug therapy. The fact these treatments are successful suggests the underlying cognitive explanations are valid.
Clark and Beck (1999) reviewed research on depression and concluded that there was solid support for all these cognitive vulnerability factors.The cognitions can be seen before depression develops,
suggesting that Beck may be right about cognition causingdepression.
Negative:
The Beck’s theory explains the basic symptoms of depression however it is a complex disorder with a range of symptoms, not all of which can be explained.(Cotard syndrome – the delusion that you are a zombie (Jarrett, 2013))
Ellis’s theory only offers a partial explanation.Some depression does occur as a result of an activating event (reactive depression ). However not all depression arises as a result of an obvious cause
Many people with depression also experience anger, and people with bipolar depression experience manic phases, times when they feel extremely happy, overly excited, confident and focused. These features of some types of depression are hard to explain with theories like Beck’s that explain depression as due to negative schemas, as schemas are resistant to change.
Family studies and genetic research suggests a predisposition to depression is inherited, likely genes that influence the activity of neurochemicals like serotonin in the brain; also, the effectiveness of drug treatments like SSRIs suggests the cognitive explanation is not complete, and there is a biological aspect to depression.
Cognitive theories depend on the assumption that the person with depression’s thoughts are irrational; it could be depression is a reasonable response to the challenges they face, for example, poverty and racism. People without depression may have a cognitive bias; they live their lives with rose-tinted glasses, selectively perceiving the world in a positive light, having overly positive self-evaluations and unrealistic optimism; people with depression see the world without this positive bias.
Explain Beck’s CBT
Patient as a scientist: The patient generates and tests hypotheses about the validity of their irrational thoughts; when they realise their thoughts don’t match reality, this will change their schemas, and the irrational thoughts can be discarded.
Patient also carry out thought catching: identifying irrational thoughts coming from the negative triad of schemas. This is done through homework tasks such as keeping a diary, which is used to record negative thoughts and identify situations that cause negative thinking.
The therapist encourages behavioural activation: Taking part in activities that the sufferer used to enjoy (e.g. sports, travelling or socialising)
Explain Ellis’s REBT
Rational emotive behaviour therapy: Development of the ABC model, adding D for dispute and E for effect irrational thoughts are the main cause of all types of emotional distress and behaviour disorders.
Dispute: the therapist confronting the client’s irrational beliefs. Empirical arguments challenge the client to provide evidence for their irrational beliefs, while logical arguments attempt to show that the beliefs don’t make sense.
Effect: reduction of irrational thoughts (restructured beliefs B) leading to better consequences (C) in the future.
Shame attacking exercises: The client to performs a behaviour they fear doing in front of others. This shows the client they can act against their emotions and cope with an unpleasant experience, and they can survive other people’s disapproval. And actually, most people don’t notice or care about our actions
Difference between Beck’s CBT and Ellis’s REBT
Difference: In Beck’s CBT therapy, the client is helped to figure out the irrationality of their thoughts themselves by acting as a scientist. In Ellis’s REBT, the therapist explains the irrationality of the thoughts directly to the patient through disputation.
Evaluate the cognitive approach to treating depression
Positive:
Finding the effective treatment for a disorder would be beneficial for society. WHO has predicted that by 2020 depression will be the greatest disorder to affect society. Therefore, if psychological research shows that people with a disorder such as depression are less likely to suffer a relapse after having cognitive therapy then, even though cognitive therapy might initially be more expensive than drug therapy, in the long-term it might be more economically sound to offer cognitive therapy as people would have less time off work
Cognitive primacy-Cognitive explanations for depression share the idea that
cognition causes depression.The idea that emotions are influenced by cognition Other theories of depression see emotion as stored, similarly to physical energy, to emerge some time after its causal event.
Like Beck’s explanation, Ellis’ explanation has led to successful therapy.Irrational negative beliefs are challenged and this can help to reduce depressive symptoms suggesting that the irrational beliefs had some role in the depression (Lipsky et al. 1980)
Beck’s cognitive explanation forms the basis of cognitive behavioural therapy. All cognitive aspects of depression can be challenges in CBT.This includes the components of the negative triad, that are easily
identifiable.This means that a therapist can challenge them and encourage the patient to test whether they are true. This suggests that therapy will be more successful.
March (2007) randomly assigned 327 patients to one of three groups, CBT, drug therapy (the SSRI fluoxetine) and the third group was given a combined treatment of CBT and drug therapy. After 36 weeks, CBT and drug therapy had an effectiveness rate of 81%. CBT also had a more significant reduction in suicidal events than drug treatment. The best results came from the combination treatment, with an effectiveness rate of 86% and fewer suicidal events than either treatment alone.
Some people with depression are too severely depressed to engage with the demands of CBT; completing homework, challenging irrational thoughts and attending sessions require motivation and commitment. Therefore, drug therapy may be required to stabilise a patient before psychological treatment.
CBT assigns an active role to patients, giving them the responsibility to overcome their depression using tools provided by therapists. Advocates of CBT say this approach empowers patients and gives a sense of personal efficacy, enabling them to take control of their lives and make positive changes. In contrast, drugs often require a passive role where patients are reliant on biological intervention and may feel helpless. Critics of CBT argue saying the client is responsible for the depression is victim blaming and suggesting depression is all in the mind and would go away if the client just thought differently, leads to clients feeling shame and wider society thinking mental health conditions are less serious than other medical conditions.
Negative:
It is as effective as antidepressants for many types of depression (Fava et al . 1994)
Keller et al ( 2000) Recovery rates (from depression):
• 55% drugs alone
• 52% CBT alone
• 85% when used together.
Both REBT and CBT may be overly focused on the present and how to restructure how the client thinks about their current situation cognitively. Clients may want to discuss severe trauma in their past, also reinterpreting present experiences does not necessarily improve the present situation; it may be that the client is in an unhealthy relationship, is experiencing unfulfilling work, discrimination or has financial problems, concerns about these social problems are not irrational.
As CBT can take 16 to 20 sessions with a trained therapist, it is an expensive treatment option. However, many patients prefer CBT to drugs due to the lack of side effects and a belief that CBT addresses the root cause of depression, not just reducing symptoms, as CBT is effective in the long term, with people able to return to work as productive workers and continue contributing to the economy. From a cost-benefit analysis, many feel CBT is worth the expense.
In some cases depression may be so severe that patients cannot motivate themselves to engage in the therapy. In these cases, it is possible to treat the patient with antidepressants and then CBT can commence at a later date.This is therefore a limitation as it means that CBT cannot be used as the sole treatment in all cases
Success may be due to the therapist-patient relationship (Rosenzweig, 1936)- Research has shown that there is little difference between CBT and other forms of psychotherapy. It may be the quality of the therapist- patient relationship that makes the difference to the success of the treatment rather than the treatment itself.Simply having the opportunity to talk to someone who will listen could be what matters most
An over-emphasis on cognition: There is a risk that in focusing on what is happening in the mind of the individual may end up minimising the importance of the circumstances the individual is living in. There is thus an ethical issue for cognitive behavioural therapists here, and it is important for therapists to keep in mind that not all problems are in the mind- (McCusker, 2014)
Explain weissman and Beck (1978 psychopathology)
Aim:
Method:
Result:
Conclusion:
AIM: to investigate the thought processes of depressed people to establish if they make use of negative schemas
METHOD: thought processes were measured using the Dysfunctional Attitude Scale (DAS). Participants were asked to fill in a questionnaire by ticking whether they agreed or disagreed with a set of statements. For example, ‘people will probably think less of me if I make a mistake’.
RESULT: they found that participants with depression made more negative assessments than people without depression. When given some therapy to challenge and change their negative schemas there was an improvement in their self-ratings
CONCLUSION: Depression involves the use of negative schemas
Key ideas behind CBT (psychopathology)
• CBT is the most commonly used psychological treatment for depression, as well as other mental health problems (e.g. anxiety, panic, phobias, stress, bulimia, OCD, Post- Traumatic Stress Disorder, bipolar disorder, etc.)
• This is a method for treating mental disorders based on both behavioural and cognitive techniques
• The therapist aims to make the client aware of the relationship between thought, emotion and actions
• CBT can help people to change how they think (‘cognitive’) and what they do (‘behaviour’). These changes can help them to feel better.
What is CBT
It is a way of talking (psychotherapy) about:
-how you think about yourself, the world and
other people
-how what you do affects your thoughts and
feelings.
From the cognitive point of view therapy aims to deal with the thinking, such as challenging negative thoughts
The therapy also includes behavioural techniques such as behavioural activation (encouraging patients to engage in those activities they are avoiding)
CBT can help to break the vicious circle of maladaptive thinking, feelings and behaviour.
It focuses on the ‘here and now’ problems and difficulties. Instead of focusing on the causes of distress or symptoms in the past, it looks for ways to improve the state of mind now.
When the parts of the sequence are clearly outlined and understood, they can be changed.
CBT aims to get the person to a point where they can ‘DIY’, and work out their own ways of tackling their problems.
Explain the Method of Beck’s CBT
- First, the client will be assessed to discover the severity of their condition.
- The therapist will establish a baseline (or starting point), prior to treatment, to help monitor improvement.
- The client is asked to provide information about how they perceive themselves, the future and the world. The therapist would use a process of reality testing. The therapist might ask the client to do something to demonstrate their ability to succeed
- clients are made aware of their negative views. In this way, irrational ideas can be replaced with more optimistic and rational beliefs.
Explain Newark et al (1973)
Aim:
Method:
Result:
Conclusion:
AIM: They wanted to discover if people with psychological problems had irrational attitudes
METHOD: Two groups of participants were asked if they agreed with the following statements identified by Ellis as irrational:
• It is essential that one be loved or approved of by virtually everyone in the
community
• One must be perfectly competent, adequate and achieving in order to consider
oneself worthwhile
One group consisted of people who had been diagnosed with anxiety. The other group had no psychological problems. They were defined as ‘normal’.
RESULT: A total of 65% of the anxious participants agreed with statement a) compared to 2% of non-anxious participants. For statement b) 80% of anxious participants agreed, compared to 25% of non-anxious participants
CONCLUSION: People with emotional problems think in irrational ways
Explain the biological approach (psychopathology)
The Biological Approach:
Explains mental health conditions (including OCD) as being due to faulty physical processes. This explanation includes the physical structure of your DNA, inherited from your parents. DNA codes for other aspects of your biology, such as how neurotransmitters are processed in the synapse and the development and functioning of larger structures such as brain regions.
What is OCD
OCD affects approximately 1 in 50 people, its symptoms include obsessive thoughts and compulsive behaviours.
Obsessive thoughts are repetitive, distressing mental images or concerns that provoke anxiety.
Compulsions are actions that individuals feel they need to perform to reduce the discomfort caused by these thoughts. Unfortunately, their relief is only temporary, as obsessive thoughts quickly return.
Example of common obsession and repulsions
Obsessions:
Contamination/infection
Burglary/theft
Electrical fire
Repulsions:
Cleaning hand or surfaces
Checking if doors and windows are locked
Checking if switches are off
What is the biological approach to explaining OCD (genetic explanation)
(Use an example)
There is no one OCD gene; however, it’s thought a vulnerability or predisposition to OCD is inherited from parents.Genetic analysis has revealed around 230 separate “candidate genes” found more frequently in people with OCD; many candidate genes influence the functioning of neural systems in the brain; for example, the SERT gene affects reuptake in the serotonin system. There are also many other genes identified with OCD.
As so many candidate genes have been identified, this suggests OCD is polygenic, meaning a predisposition to OCD requires a range of genetic changes.
Evidence for the heritability of OCD comes from family and twin studies. As the prevalence rate of OCD in the general population is 2%, the concordance rate (the odds of one person having a trait if the other does) between someone with OCD and a random stranger is also 2%
However, with OCD, the more closely genetically related two people are, the higher the concordance; first-degree relatives have 10% concordance, and non-identical/ dizygotic twins have 31% concordance (50% shared genes). Identical/monozygotic twins share 100% of their genes and have a 68% concordance rate. This suggests a predisposition to OCD is inherited.
What is the biological approach to explaining OCD (neural link)
Neural explanations for OCD: include biochemical causes, an imbalance of neurotransmitters (chemicals that communicate information between neurons) and the large neural structures in the brain that are made of many neurons (cells).
Explain the biological approach to explaining OCD (serotonin)
Low serotonin levels are thought to cause obsessive thoughts, and the low level of serotonin is likely due to it being removed too quickly from the synapse before it has been able to transmit its signal / influence the postsynaptic cell.
Serotonin and other neurotransmitters are chemical messengers; presynaptic neurons release neurotransmitters, and receptors on the postsynaptic neuron detect these; if the signal is strong enough, then the message is passed on, the neurotransmitters detach from the receptors and are taken back to the presynaptic neuron through a process called reuptake.
It seems this process happens too quickly in people with OCD, leading to reduced serotonin levels in the synapse.
The SERT gene is the gene responsible for serotonin transportation in the synapse.
Another possible candidate gene is the COMT gene – this regulates the production of dopamine
• Dopamine effects motivation and drive
Explain the biological approach to explaining OCD (neural structure)
The “worry circuit”. A set of brain structures including the orbitofrontal cortex (OFC) (rational decision making), the basal ganglia system, especially the caudate nucleus, and the thalamus.
Communication between these structures in the worry circuit appears to be overactive in people with OCD
In normal functioning, the basal ganglia filter out minor worries coming from the OFC, but if this area is hyperactive, even small worries get to the thalamus, which is then passed back to the OFC, forming a loop (recurring obsessive thoughts)
Repetitive motor functions (compulsions) are an attempt to break this loop. While carrying out the compulsion may give temporary relief, the hyperactive basal ganglia will soon resume the worry circuit.
The Parahippocampal gyrus, an area of cortex close to the hippocampus on the brain’s underside, is also linked to OCD. It is responsible for regulating and processing unpleasant emotions and has been seen to function abnormally in cases of OCD.
Evaluate the biological approach to explain OCD
Positive:
Individuals may gain a vulnerability towards OCD through genes that is then triggered by an environmental stressor.
Candidate genes are ones which, through
research, have been implicated in the
development of OCD
Nestadt (2010) shows for OCD; there is a high concordance rate between close family members. Non-identical twins have 31% concordance, and identical twins have 68%. MZ and DZ twins grow up sharing similar environments like food, upbringing and education, and life events like bereavement or parental divorce. This suggests that the additional shared DNA is responsible for the increased concordance.
Nestadt.
Several neuroimaging studies using PET scanners have shown hyperactivity in the OFC and the caudate nucleus in people with OCD both while scanning the brain at rest and when symptoms are stimulated, but there is a problem with this neural evidence, it is correlational; researchers cannot be sure if the hyperactivity in these areas is the cause of OCD or a consequence of having OCD.
Negative:
Close relatives of OCD sufferers may have
observed and imitated the behaviour (SLT)
There are too many genes involved therefore psychologists have not been successful at pinning down all the genes involved. Each genetic variation only increases the risk of OCD by a fraction
Cromer (2007) found that over half the OCD patients in their sample had a traumatic event in the past, and that OCD was more severe in those with more than one trauma.
The biological approach does not take into consideration other approaches in psychology. It is reductionist. Therefore, it is better to focus on environmental causes on OCD than genetics.
The correlation in family and twin studies does not automatically equal causation. It may not be the shared genetics behind the high concordance rates; closer family members also share similar environments; identical monozygotic twins may be treated more similarly because they look alike, compared to dizygotic, non-identical twins. As the concordance rate for identical twins at 68%, not 100%, the level we would expect for an entirely genetically determined psychological feature, so there must be some role for the environment
The Diathesis stress response may be a more valid explanation for OCD than biological processes alone. Individuals inherit a genetic vulnerability to OCD (diathesis). However, the disorder does not develop unless there is an environmental factor (stressor), such as a traumatic life experience. Cromer showed 54% of 265 participants with OCD reported at least one traumatic life event, and those with traumatic life events reported increased severity of OCD symptoms; this demonstrates an environmental aspect of OCD.
A meta-analysis by Soomro demonstrated SSRIs are more effective than placebos, suggesting there is a biological aspect to OCD however despite altering levels of serotonin in the synapse within hours, these drugs take weeks to reduce symptoms, and 40% to 60% of patients show no or just partial symptom improvement. These findings suggest low levels of serotonin have a role to play in OCD but are not the sole cause of OCD.
Explain the biological approach to treating OCD (drug therapy)
The primary class of drugs used to control the symptoms of OCD are a group of antidepressant drugs called SSRis, e.g. Fluoxetine
SSRIs are called Selective Serotonin Reuptake Inhibitors-They only influence (select) serotonin in the brain; as reuptake inhibitors, they inhibit (slow down) the reuptake process in the synapse. Therefore serotonin is still present in the synaptic cleft and continues to stimulate the postsynaptic neuron. This decreases anxiety by normalising the activity of the worry circuit.
SRis can take three to four months to reduce symptoms, and for some patients, SSRIs are not effective. The dosage can be increased for drug-resistant patients or other treatment options attempted, such as anti-anxiety drugs like benzodiazepines. These work by enhancing a neurotransmitter called GABA, slowing the central nervous system and resulting in general relaxation.
Tricyclics and SNRis work by increasing serotonin and noradrenaline; these drugs can be effective when SSRIs fail, but because they work on multiple neurotransmitters (non-selective), they tend to have more intense side effects.
Evaluate the biological approach to treating OCD
Positive:
Allows medication to be developed which helps sufferers.
Advances in technology have allowed researchers to investigate specific areas of the brain more accurately, and OCD sufferers do seem to have excessive activity in the orbital frontal cortex
Soomo conducted a meta-analysis combining the data from 17 studies that compared SSRis to placebos. In total, there were 3097 participants. The results of this large-scale meta-analysis showed that SSRIs significantly reduced the symptoms of OCD compared to placebos between 6 and 17 weeks post-treatment. These results suggest drug therapy is effective in the short term.
Drug therapy is a relatively inexpensive and potentially more convenient treatment for the patient; this is in comparison to psychological therapies like CBT, which require the patient to find time for multiple sessions with a trained therapist. As CBT is much more expensive than drug therapy, from an economic perspective, health services like the NHS are more likely to provide drug therapy.
Negative:
Drugs are not completely effective. Just because administering SSRIs decreases OCD symptoms, does not mean that lower levels of serotonin are a cause of the OCD. There is time delay between taking drugs to target the condition and any improvements being made and yet the chemical imbalance is addressed in hours
The repetitive acts (compulsions) may be explained by the structural abnormality of the basal ganglia but not necessarily the obsessional thoughts.
There are inconsistencies found in the research as no system has been found that always plays a role in OCD
These neural changes could be as a result of suffering from the disorder, not necessarily the cause of it
Goldacre points out that most research studies on drug therapies are conducted by the pharmaceutical companies that created them. This means the companies have a financial interest in showing the drugs are effective; this, and the file drawer problem (the fact that many negative results stay unpublished), means any metanalysis may be skewed, and drug therapies may not be as effective as claimed.
Many patients prefer CBT; one reason is drug therapy can have a range of potential side effects; in the Soomro meta-analysis, it was found nausea, headache and insomnia were the most common side effects. Also, with drug therapy, it can take four months before the patient experiences symptom reduction, and patients can become dependent on the drugs.
Drug therapies may only cover up the symptoms of OCD, not treat the cause. It’s argued serotonin imbalance is a result of OCD, not the cause. This means the origin of OCD may not be biological but, instead, be due to a traumatic experience. Cromer (2007) showed 54% of 265 participants with OCD reported at least one traumatic life event, and those with traumatic life events reported increased severity of OCD symptoms. This suggests drug therapy may only be a temporary solution, and psychological therapies that address these traumatic life events may be a more effective long-term treatment.
what are three studies which show that OCD is caused from biological factors
• Billet et al. (1998 ) and Bellodi et al. (2001) laim that genetic factors play a role in the development of OCD: Using evidence from twin studies and family studies, they showed that close relatives are more likely to have the disorder than more distant relatives.
• Mckeon and Murray (1987)- patients with OCD are more likely to have first degree relatives who suffer from anxiety disorders.
• Lewis (1936) and Pauls et al. (2005) there is a higher percentage of OCD sufferers in relatives of patients with OCD than in the control group without
OCD.
Define obsession
A persistent thought, idea, impulse or image that experienced repeatedly, feels intrusive and causes anxiety
Define compulsion
A repetitive and rigid behaviour or mental act that a person feels driven to perform in order to prevent or reduce anxiety
What are the DSM_5 categories of OCD
The DSM recognises OCD and a range of related disorders:
• OCD - characterised by obsessions and/or compulsions
• TRICHOTILLOMANIA - compulsive hair pulling.
• HOARDING DISORDER - the compulsive gathering of possessions and the inability to part with anything regardless of its value
• EXCORIATION DISORDER - compulsive skin picking.
What does the DSM describe the main symptoms of OCD as
Recurrent obsessions and compulsions
Recognition by the individual that the obsessions and compulsions are excessive and/or unreasonable
That the person is distressed or impaired, and
What are some characteristics of OCD
Behavioural: how a person acts (behaves) which typically leads to the carrying out of repetitive actions to reduce anxiety. This often leads to avoidance of situations that trigger anxiety.
Emotional:
• OCD may feel depressed and/or other negative emotions
• Guilt and disgust
Cognitive:
• OCD sufferers are usually plagued with obsessive thoughts. They also tend to develop cognitive strategies
• Anxiety
Explain aetiologically heterogenous
The origin of OCD has different causes.
Different genetic variation or genes cause the disorder in different people.
