topic 4: psychopathology

Question 1

define abnormality

Answer 1

abnormality is;
i. statistical infrequency
ii. deviation from social norms
iii. deviation from ideal mental health
iv. failure to function

Question 2

outline the ‘deviation from social norms’ definition of abnormality

Answer 2

it suggests that ‘abnormal’ behaviour is
based on straying from culture specific social norms. There are general norms, applicable to most cultures, as well as culture-specific norms.

eg;
- behaving aggressively towards strangers (breaks general social norm) –> diagnosed with antisocial personality disorder (APD)
vs
- experiencing certain hallucinations –> schizoprenia/spiritual connection

Question 3

what are social norms

Answer 3

they are judged by the dominant culture, they’re the unwritten rules for expected/appropriate social behaviour

Question 4

when can social norms differ

Answer 4

between cultures, different eras, genders, age, religion

Question 5

what are the negatives of using ‘deviation from social norms’ as a definition of abnormality

Answer 5

– the wide variety of mental health diagnoses between cultures based on this definition has historically led to discrimination
eg. nymphomania in 1800s GB - when women were sexually attracted to middle class men; but this diagnoses was just made to prevent infidelity + cement social class divisions and discriminate further against women

– cultural relativism as it relies on subjective social norms
eg. voices/hallucinations
africans and asians - sign of spirituality and ancestral connection
western - symptom of schizoprenia
therefore this definition can lead to discrepancies in mental health disorder diagnoses between cultures

Question 6

what are examples of functioning effectively

Answer 6

social interaction, sleeping, brushing your teeth, getting dressed, getting out of bed

being able to deal with the demands of everyday living

Question 7

what are indicators of failing to function effectively and who found them

Answer 7

Rosenhan and Seligman
1. observer discomfort
2. unpredictability
3. irrational behaviour
4. maladaptive behaviour (it doesn’t help them in adapting to daily life)
5. personal distress
6. violations of moral standards
7. unconventionality

Question 8

evaluate the failure to function definition of abnormality

Answer 8

+ observable behaviour
+ provides a practical checklist to check behaviours
- why should someone else be able to decide if an individual is functioning effectively, failing to function/alternate lifestyle?

• some people can appear to function effectively when they actually aren’t (Dr Death, Harold Shipman)
• env. situation should be considered, eg. bereavement; but for how long?

Question 9

what did Marie Jahoda describe as characteristics of being ‘normal’ and having ideal mental health

Answer 9

1. autonomy - being independent and able to make you’re own decisions
2. self attitudes - having high self esteem and a strong sense of personal identity
3. accurate perception of reality - ability to form a realistic judgment of themselves and actions of others
4. self-actualisation - the extent to which a person develops to their full capacities
5. mastery of the environment - behaving appropriately in different situations with different people
6. integration - being able to cope in the social world, eg. managing stressful situations

Question 10

evaluate the deviation from ideal mental health definition of abnormality

Answer 10

– unrealistic expectation of ideal mental health
a majority of the population can’t acquire/ maintain the listed criteria and would be considered as abnormal

+ it takes many factors into account and considers abnormality from a very individual perspective

– it’s based off of similar models for physical health, but mental health is different

the more of the characteristics that aren’t met, the more abnormal you are

Question 11

explain the statistical infrequency definition of abnormality

Answer 11

it considers the number of people with a ‘behaviour’ as a means of identifying/defining abnormality’s rare/statsitically infrequent behaviour becomes classed as abnormal

it relies on using up to date stats

says that abnormal is the extreme ends of a normal distribution curve

it involves giving behaviours an objective score to quantify it

Question 12

evaluate statistical infrequency as a definition of abnormality

Answer 12

+ often used in mental health diagnosis clinically
used often to compare with a baseline/normal value and assess a disorder’s severity
eg,. schizophrenia affects 1% of population but sub-types are even less frequent

– it assumes that an abnormal characteristic must be negative
isn’t always the case; eg. having an IQ score over 130 and thus making you a genius would rarely been seen as requiring treatment

– some relatively common disorders are seen as abnormal
eg. depression is found in 1 in 6 people at some point in their lifetime

Question 13

what is a phobia

Answer 13

an irrational, fearful anxiety in response to a specific object/situation

it is marked, persistent and disproportionate to the danger

Question 14

what are the behavioural, emotional and cognitive characteristics of a phobia

Answer 14

behavioural: panic, avoidance, escape, endurance

emotional: fear, anxiety, high degree of distress, irritability

cognitive: irrationality, difficulty concentrating, cognitive distortions, selective attention

Question 15

what is the two-process model

Answer 15

1. acquisition through classical conditioning
2. maintenance through operant conditioning

the phobia causes anxiety/feeling unwell/increased heart rate, negative reinforcement then works to increase the behaviour because escaping the situation causes relief which acts as a reward

Escape/avoidance is now negatively reinforced and escape increases

one trial learning: the one experience is also then generalised

Question 16

outline the study by Watson and Rayner

Answer 16

little Albert, Watson and rayner

an example of classical conditioning
he was 9 months, healthy and not very emotional - always in a hospital setting

Albert was introduced to various neutral stimuli, eg. white rat, monkey, dog, newspaper on fire; had no negative responses

a hammer was hit causing a sudden loud noise - this is an unconditioned stimulus

the noise and rat were increasing linked until the rat became the conditioned stimulus, Albert learned to be scared of the cat and also generalised this fear eg. Santa, dogs etc.

he was never unconditioned

Question 17

evaluate the two-process model explanation of phobias

Answer 17

— doesn’t explain cognitive factors associated with phobias, such as irrational thinking. seligmann says that biological preparedness could explain why we have a preprogrammed fear of certain things that could have been life threatening to ancestors

+ treatments have developed from the behaviourism explanation

– biological approach suggests that phobias could have an evolutionary explanation
eg. a fear of germs could be because germs can reduce life longevity

– Ohman (1975) made people afraid of both fear relevant and irrelevant stimuli; found that it was easier to make them afraid of fear relevant stimuli which supports the biological approach

Question 18

what are the behavioural treatment methods of phobias

Answer 18

• systematic desensitisation
• flooding

Question 19

what is involved in systematic desensitisation

Answer 19

the anxiety hierarchy - patient and therapist work together and rank situations with the phobia from most to least frightening

relaxation techniques - it is impossible to be simultaneously relaxed and afraid; breathing excercises/imagination techniques/even medication could be used for relaxation

gradual exposure - the patient is exposed to the phobic stimulus that is at the lowest point on the hierarchy while they’re in a relaxed state; it is likely to take several sessions
move up the hierarchy

they have to get relaxed because fear and relaxation cannot coexist

the bond between the phobic stimulus and fear has to be broken and replaced with relaxation

Question 20

what is flooding

Answer 20

patients are exposed to their phobic stimulus without a gradual build up through anxiety hierarchy. the exposure is immediate and has to be for a prolonged period of time (prevent avoidance), long enough that they’re calm in the presence of the phobia

leaving before this could worsen the phobia as they now relate a traumatic event to the phobia

it works because after a prolonged period of time ur fight or flight has to stop as the heart beat just can’t last; exhaustion of the phobic response

Question 21

evaluate behavioural treatment options for phobias

Answer 21

– SD can’t be used with situational phobias very well because it’s difficult to establish an anxiety hierarchy

+ can be self-administered and is just effective when done in that way!!! yay!!

+ they can work very quickly, there is evidence to suggest that 90% of patients can have reduced anxiety after one therapy session

– SD can rely on imagination and some people can’t imagine vividly, it also means that the SD might not work when the situation is actually being experienced because the SD was done covertly

– ethically, both treatments cause distress health conditions are assessed prior to flooding as it can cause heart attacks; have to get informed consent and really try to prevent them leaving before calm
however, long term quality of life benefits usually outweigh low quality of life

Question 22

what is OCD

Answer 22

OCD is when someone has obsessive thoughts and compulsive behaviours that cause them anxiety

a diagnosis is given when specific symptoms are present most days over at least 2 successive weeks and cause significant distress/interference with other activities

Question 23

what are the emotional, behavioural and cognitive characteristics of ocd

Answer 23

emotional: anxiety, guilt, distress, depression
behavioural: compulsions; checking, cleaning, mental compulsions
cognitive: obsessive thoughts ; irrational, contamination, selective attention

Question 24

what was Nestadts study on OCD

Answer 24

Nestadt 2000 found a 12% incidence of first degree relative also having OCD

so there could be a genetic vulnerability for OCD

Question 25

what is the diathesis stress model

Answer 25

there is to be a trigger for the OCD to actually be experienced in conjunction with an individuals genetic predisposition to developing the disorder

Question 26

define aetiologically heterogenous

Answer 26

different genes can cause a different OCD in different people

Question 27

evaluate a genetic explanation of OCD

Answer 27

+ there is a strong link shown between genes and OCD
Miguel (2005) found around 70% concordance with MZ twins and 35% with DZ

– if it was purely genetic then MZ concordance would be 100%, but it isn’t

Question 28

what is a genetic explanation of OCD and what evidence supports it

Answer 28

OCD is caused by low serotonin; the SERT gene is known to be involved with serotonin regulation; PET scans have found lower serotonin in people with the SERT gene

Soomro found that if a first generation relative has OCD, a family member is 5x more likely to have it too (1stgen - 10% vs gen pop 2%)

MZ: 70%
DZ: 35%

this is because serotonin is an inhibitory neurotransmitter that stops task repetition so low levels make one more likely to repeat a task

Question 29

what is a neural explanation of OCD

Answer 29

abnormality/damage in the basal ganglia have been found to have a higher incidence with OCD
BUT patients with an unaffected basal ganglia also have OCD

an overactive orbital frontal cortex also has a link with OCD, and severing the connection between the orbito-frontal cortex and the basal ganglia reduces OC

basal ganglia is linked to compulsions and orbito-frontal is linked to obsessions and ‘the worry circuit’

Question 30

what is the basal ganglia

Answer 30

a number of structures responsible for motor control and emotional expression

Question 31

what is the orbito-frontal cortex

Answer 31

involves decision making and logical thinking, it turns sensory information into thoughts and actions

Question 32

what is an evolutionary explanation for OCD

Answer 32

some of these behaviours could serve to increase our gene pool

eg. grooming behaviour, hoarding, concern for others

Question 33

what are the treatment options for OCD

Answer 33

• selective serotonin reuptake inhibitors (SSRI’s) - these block serotonin absorption through reuptake cells which leaves more in the synapse; more serotonin is then received by the post synaptic neuron

they take 3-4 months of daily use to see an impact on symptoms

• SNRI’s, increase levels of serotonin and noradrenaline
• psychosurgery - removal or disconnection of brain regions to relieve OCD symptoms
• TMS (Transcranial Magnetic Stimulation)
  it was shown to work by Greenburg et al. 1997
  TMS was used on frontal sites for 20 minutes and there was a reduction in compulsive behaviour for 8 hours
  But Rodriguez-martin et al 2003 found a TMS placebo produced almost the same results

Question 34

evaluate the use of Selective Serotonin Reuptake Inhibitors (SSRI’s)

Answer 34

• there could be serious side effects like weight gain, increased heart rate, erection issues. could impact a lot of daily life
• relapse rate is higher in patients using drug treatment than psychological treatment

+ SSRI’s have been proven effective through a lot of supporting evidence

– only 50% effective and they may only improve the symptoms, not the actual root cause

Question 35

what is depression

Answer 35

it is a mood disorder, the mood and energy levels are lower than would be expected in the given circumstances

depression symptoms must cause distress/impaired functioning in social and/or occupational roles for at least 2 weeks

Question 36

what are the emotional, behavioural and cognitive characteristics of depression

Answer 36

emotional - low mood/sadness, anxious, hopelessness, anger, low self esteem

behavioural - being less social, neglecting hobbies, lower activity, self harm, insomnia, appetite changes

cognitive - poor concentrating, dwelling on negatives, absolutist thinking (either 100% good or 100% bad)

Question 37

what are the 2 cognitive explanations for depression

Answer 37

1.Beck’s negative triad theory
2. Ellis’ ABC model of depression

Question 38

what is Beck’s Negative Triad Theory

Answer 38

suggests that there are 3 parts as to why some people are more cognitively vulnerable to depression

1. faulty information processing - said that depressed ppls selectively attend to a situation’s negative aspects and ignore positives; absolutist thinking (B+W)
2. negative self schema; only noticing negatives can lead to building a negative self schema
3. negative triad; a negative view of the world + self + the future

Question 39

what is Ellis’ ABC model of depression

Answer 39

Activating event

Beliefs - they can be rational/irrational, irrational thinking can be triggered by an activating event

Consequences - healthy from rational/unhealthy from irrational

Question 40

what are the treatment options for depression

Answer 40

Cognitive Behavioural Therapy (CBT) - used by beck

Rational Emotive Behaviour Therapy (REBT) - Ellis’ ABCDE treatment

Question 41

what is CBT

Answer 41

it was used by beck
‘patient as scientist’ - patient is encouraged to reexamine their negative thoughts

ask patient to get evidence of their beliefs to challenge irrational beliefs

keep a diary of situations where depression is bad to know what to target

Cognitive restructuring, to reinforce positive thoughts

Question 42

what is Rational Emotive Behaviour Therapy (REBT)

Answer 42

aka ellis’ ABCDE therapy
Activating event
irrational Beliefs
Consequences; dysfunctional behaviour
Dispute irrational beliefs
Effect; reduced irrational thoughts

it encourages the person to break the link between the activating event and the belief by using an empirical and logical argument + shame attacking excersises

Question 43

what are some positives of CBT

Answer 43

+ it is an effective and widely used treatment
other therapies have even been formed on the same basis
March et al. found CBT to have = effectiveness to antidepressants
improvement; 81% for CBT, 81% for antidepressants, 86% for CBT+antidepressants

+ therapy has no side effects or withdrawal issues, whereas medication is likely to have both

+ it deals with the root cause rather than just symptoms

+ the patient has the power to change and has control over the disorder

Question 44

what are some negatives of CBT

Answer 44

– it may not work for severe depression cases
it can be v hard to explain why when your thinking is so negative
a med+CBT approach could be better because it focuses on depression caused by both biological+cognitive factors

– people still relapse; 19% in March’s study didn’t have a significant improvement with CBT
— ineffective for people lacking insight into motivations (eg. disabled children) and ppl resistant to change so this limits effectiveness

– it relies on the therapist-patient relationship
the person will have to report their thoughts which can be unreliable; talking about thoughts can also be v hard so if you’re unable to engage then the therapist might stop it
if a therapist is challenging you it can feel like you’re misunderstood
BUT for some, the social element of talking to someone and being listened to can help more than the patient changing their thought process and cognition

– expensive and time consuming, change can take months longer to see than when using drugs

Question 45

evaluate the cognitive explanation of depression

Answer 45

+ a study found depressed people to have more errors in logic than non depressed people, supporting the idea that it can be caused by irrational thinking

– the approach suggests that the client is at fault for their mental state and can be useful but can also result in other factors (work, family etc.) being ignored when they’re the issue

+ SSRI’s are effective which suggests that there is some accuracy in the biological approach
the diathesis stress model is a compromise bc it suggests a biological predisposition that is triggered by an event and then cognition is part of the prob

+ depressed individuals became more depressed when given negative thought statements, but it’s hard to determine whether this is from them thinking negatively because of depression or getting depressed because of the negative thoughts

Question 46

what are the biological OCD explanations

Answer 46

1. SERT gene
2. abnormal basal ganglia and overactive orbito-frontal cortex
3. evolution

Question 47

outline and evaluate REBT

Answer 47

ABCDE dispute irrational beliefs logically, empirically and pragmatically
gave pts unconditional positive regard because if they feel worthless they are unlikely to persist with treatment
may get asked to do hw between sessions to test their irrational beliefs against reality

— ellis claimed a 90% success rate but it’s a self-assessment and may not be accurate and he later said it might not always be effective bc of clients not putting revised beliefs into practice

— drug therapies need a lot less effort and have been proven to be an effective option

Question 48

evaluate the biological explanation of OCD

Answer 48

+-35 v 70 but not 100

— diathesis stress is an alternate explanation

+ SSRI’s are a good treatment option

— screenings can be done to check for SERT and mothers may choose to stop the pregnancy, but the genes may not even directly cause it and then yk

Question 49

evaluate OCD treatment options

Answer 49

— drug therapies are effective when used but after you stop, symptoms return which makes them not an effective long term solution

+ quick treatment that needs less effort from pt compared to stuff like CBT and they’re much cheaper with no therapists needing to be trained

— side effects especially with tricyclics because they can cause palpitations and hallucination

— behaviourist treatment has been just as effective
exposure response prevention therapy where you are exposed to the obsessive stimulus but prevented from carrying out the associated compulsive behaviour