Topic 4 - Psychopathology (complete!!!!)

Question 1

Explain statistical infrequency as a definition of abnormality

Answer 1

• Statistical infrequency = occurs when an individual has a lesson common characteristic in proportion to the population
• Those who are statistically infrequent are classed as abnormal
• According to the statistical definition, any common behaviour or characteristic within a population regarded as ‘normal’
• Any behaviour or characteristic that is uncommon (i.e. a very small proportion of the population has it) is regarded as ‘abnormal’
• Often used when we are dealing with characteristics that can be reliably measured e.g. IQ
• Majority of people’s scores will cluster around the mean, the further we go above or below this average the fewer will have that score - known as NORMAL DISTRIBUTION
• Produces a BELL SHAPED curve
• Mean IQ is 100 - most of the population (68%) have an IQ within this mean i.e. 85-115
• 94% of population have an IQ ranging from 70-130 (people who lie within this range = ‘normal’ as they have a characteristic common within the population)
• Only 2% of population have IQ above 130 and only another 2% of population have IQ below 70
• Those with IQ below 70 are very unusual (they have an uncommon characteristic when compared to the population) and so are ‘abnormal’ - often get diagnosis of ‘intellectual disability disorder’

Question 2

Statistical infrequency as a definition of abnormality has real life application - state whether this is a strength or a weakness and explain why

Answer 2

STRENGTH

Used in clinical practice, both as part of formal diagnosis + as a way to assess the severity of a persons symptoms

E.g. diagnosis of intellectual disability disorder requires and IQ of below 70 (only 2% of population therefore statistically infrequent)

Also used in the BECK DEPRESSION INVENTORY (BDI) - a score of 30+ (top 5% of respondents) is widely interpreted as indicating severe depression

Statistical infrequency is a reliable quantitative measure for diagnosis - OBJECTIVE in it measurements as it considers the numerical infrequency rather than the SUBJECTIVE interpretation of a persons behaviours

Shows the REAL LIFE PRACTICAL VALUE of the statistical infrequency criterion in diagnostic and assessment processes

Question 3

Statistical infrequency as a definition of abnormality does not consider that being infrequent in a population isn’t always regarded as ‘abnormal’ within a society - state whether this is a strength or a weakness and explain why

Answer 3

WEAKNESS

Infrequent characteristic can be positive as well as negative - i.e. being statistically infrequent doesn’t always lead to diagnosis

For every person with an IQ below 70 there is another with an IQ above 130 - yet we would not think of someone as abnormal for having a high IQ, in fact we would celebrate it

Similarly, we would not think of someone with a very low depression score on the BDI as abnormal, even if they are statistically infrequent

Therefore statistically infrequency cannot be the sole definition of abnormality as not all statistically infrequent people are regarded as abnormal

Means that, although statistical infrequency can form part of assessment and diagnostic procedures, it is never sufficient as the sole basis for defining abnormality

Question 4

There is a debate on whether statistical infrequency as a definition of abnormality is more beneficial or whether it does more harm then good - discuss these arguments

Answer 4

Some statistically infrequent people benefit from being classed as abnormal

E.g. someone with a very low IQ and is then diagnosed with intellectual disability can then access support services or someone with a very high depression BDI score can benefit from the therapy given through diagnosis

However, not all statistically infrequent people benefit from this label - in fact, being ‘abnormal’ usually holds negative connotations, whilst this may not be at the fault of the definition itself its important to note that labelling someone as abnormal due to their statistical infrequency may create a social stigma around them and do more harm then good

E.g. someone with a low IQ who can cope with their chosen lifestyle without help from services may feel burdened by the label of being ‘statistically infrequent’

Therefore need to carefully evaluate the benefits and harm the statistical infrequency definition can bring

Question 5

Explain deviation from social norms as a definition of abnormality

Answer 5

• Deviation from social norms = concerns behaviour that is different from the accepted standards of behaviour in a community or society
• Groups of people ( e.g. societies, communities) choose to define behaviour as abnormal on the basis that it offends their sense of what is ‘acceptable’ (i.e. their norm)
• There is a collective judgement as a society on the interpretation of the norm
• Social norms vary between generations and between every culture therefore there are very few universal abnormalities on the terms that it breaks a universal social norm
• E.g. homosexuality is not seen as abnormal in some countries, whereas in others it is as it breaks their perception of the social norm
• Antisocial personality disorder (APD) is on of the few characteristics which is generally regarded as a ‘universal norm’
• According to DSM-5 an important symptom of APD is “an absence of PROSOCIAL internal standards associated with failure to conform to lawful and CULTURALLY NORMATIVE ethical behaviour”
• Therefore APD generally considered a somewhat universal abnormality because a symptom is the inability to follow the moral social norm of the culture the person is being diagnosed from

Question 6

Deviation from social norms as a definition of abnormality has real world application - state whether this is a strength or a weakness and explain why

Answer 6

STRENGTH

Used in clinical practice

E.g. key defining characteristic of antisocial personality disorder = failure to conform the the culturally acceptable ‘moral norm’ by showing aggressive behaviour, lack of empathy etc.

These signs of APD are all deviations from social norms - therefore can be used as a diagnostic tool for this mental disorder

Such norms also play into diagnosis of schizoptypal personality disorder - where term ‘abnormal’ used to characterise the thinking, behaviour and appearance of those with the disorder where it goes against social norms

Shows that the deviation from social norms definition criterion has REAL LIFE PRACTICAL VALUE in psychiatry for diagnosis

Question 7

Deviation from social norms as a definition of abnormality has cultural and situational RELATIVISM - state whether this is a strength or a weakness and explain why

Answer 7

WEAKNESS

There is a large degree of variability between social norms in different cultures and even in different situations

Person from one cultural group may label someone from another culture as abnormal using their standards

E.g. hearing voices is the norm in some cultures (as messages from ancestors) but would be seen as an abnormality, and most likely would lead to a diagnosis, in most parts of the UK

Even within one cultural context social norms differ from one situation to another

E.g. Aggressive and deceitful behaviour in the context of family life would be seen as socially unacceptable (and would often lead to a diagnosis for antisocial personality disorder) than in the context of corporate deal-making

Means that we cannot RELIABILY use this definition of abnormality as it is extremely difficulty to judge deviation from social norms across different situations and cultures

There are too many possibilities for different interpretations of the social norm for it to be a CONSISTENT DIAGNOSTIC TOOL (can be used as a COUNTERPOINT for the real world application argument) as in some cultures diagnosis of a certain behaviour may seem disproportionate whilst in others it may seem appropriate

Question 8

Deviation from social norms as a definition of abnormality has been exploited in the past to abuse some human rights - state whether this is a strength or a weakness and explain why

Answer 8

WEAKNESS

Using deviation from social norms to define someone as abnormal carries the risk of unfair labelling and leaving people open to human rights abuses

Historically this has been the case where diagnosis like nymphomania (women’s uncontrollable or excessive sexual desire - a behaviour which would go against a range of culture’s social norm) has been used to control women

Diagnoses like drapetomania (black slaves running away - a behaviour which, at the time, was seen as going against the white’s social norms) were a way to control slaves and avoid debate by accusing them with supposed ‘mental illness’

However, could argue that the definition, if handled sensitively, can be used to diagnose conditions like antisocial personality disorder and schizoptypal personality disorder

Therefore psychiatrists need to be careful when using this definition, especially with diagnosis, as it has a history of human rights abuses

Perhaps other definitions are better suited to define abnormality as this one has historically done more harm than good

Question 9

Explain ‘failure to function adequately’ as a definition of abnormality

Answer 9

• Person may cross a line between ‘normal’ and ‘abnormal’ at the point where they can no longer cope with the demands of everyday life

   When is someone failing to function adequately?

• Rosenhan + Seligman (1989) proposed additional signs when someone is not coping:

1. When person no longer conforms to standard interpersonal rules e.g. respecting personal space
2. When a person experiences severe personal stress
3. When a person’s behaviour becomes irrational or dangerous to themselves or others

Can be used to diagnose intellectual personality disorder = not only does their IQ have to be statistically infrequent (i.e. below 70) but they also have to be failing to function adequately to receive full diagnosis

Question 10

Failure to function adequately as a definition of abnormality represents a sensible threshold for when people need professional help - state whether this is a strength or a weakness and explain why

Answer 10

STRENGTH

Most of us have symptoms of mental disorder to some degree at some time

According to mental health charity, Mind, around 25% of people in the UK will experience a mental health problem in any given year

However, many people continue on even in the face of severely severe symptoms

Tends to be at the point where we cease to function adequately (i.e. when a person crosses this ‘threshold’) that people seek professional help or are noticed and referred for help by others

This criterion given by this definition means that treatment and services can be targeted at those who need it the most i.e. those who fail to function adequately

Question 11

Some argue that failure to function adequately as a definition of abnormality is discriminatory and assumes that all non-standard lifestyle choices equate to being ‘abnormal’ - state whether this is a strength or a weakness and explain why

Answer 11

WEAKNESS

In practice it’s very difficult to identify when someone is really failing to function adequately or whether their lifestyle choice simply deviates from the social norm

E.g. not having a job or permanent address may seem like failing to function, and for some people it would be. However, people in nomadic communities simply have alternative lifestyle choices and choose to travel from place to place - they aren’t failing to function even when they would fit the definition

Those who favour high-risk leisure activities (e.g. sky diving) may be unreasonably classed as irrational and perhaps danger to themselves (a key characteristic of failing to function adequately) when in reality it may just be a hobby

Means that if we use this definition of abnormality people who make unusual choices (or simply live against the social norm) are at risk of being labelled as abnormal and their freedom of choice may be restricted

Have to handle this definition with care otherwise it could easily lead to discrimination against certain cultures being defined as ‘abnormal’ e.g. nomads

Question 12

It is argued that simply failing to function does not equate to abnormality as it heavily depends on contextual factors as to why a person is failing to function - state whether this is a strength or a weakness and explain why

Answer 12

WEAKNESS

There are some circumstances in which most of us fail to cope for a time e.g. bereavement

In fact, being able to function adequately in this situation (bereavement) would actually be seen as abnormal - concept of abnormality goes completely against the definition in some cases

Therefore may be unfair to give someone a label that may cause them future problems just because they react to difficult circumstances

HOWEVER (COUNTERPOINT)

Arguably, failing to function is no less real just because the cause of it is clear

Also, some people seek professional help to adjust to circumstances like bereavement - therefore we can still use this definition to help these people seek support

Means that we need to be careful on how we label abnormality - perhaps its a situation where not all people who fail to function are abnormal, but all who are considered as abnormal fail to function in some way

The value of the definition itself may be heavily dependant on other contextual factors

Question 13

Explain deviation from ideal mental health as a definition for abnormality

Answer 13

• Those considered as abnormal deviate from ideal mental health
• Jahoda suggested that normal people have good mental health, and to have this you need to meet the following criteria:

1. No symptoms of distress
2. Rational and perceive ourselves accurately
3. Able to self-actualise (strive to meet our potential)
4. Can cope with stress
5. Have a realistic view of the world
6. Good self-esteem and lack guilt
7. Independent of other people
8. Can successfully work, love and enjoy our leisure

• Inevitably there is some overlap between what we may call deviation from mental health and what we might call failure to function adequately
• E.g. someone’s inability to keep a job can be seen as either failing to cope with the pressure of work or as a deviation from the ideal of successfully working

Question 14

Deviation from ideal mental health is a highly comprehensive definition for abnormality - state whether this is a strength or a weakness and explain why

Answer 14

STRENGTH

Jahoda’s concept of the ‘ideal mental health’ includes a range of criteria for distinguishing mental health from mental disorder

Covers most of the reasons why we might seek (or be referred to) help with mental health

In turn means that individual’s mental health can be discussed meaningfully with a range of professionals who might take different theoretical views

E.g. a medically-trained psychiatrist may focus on the symptoms using the criteria whereas a humanistic counsellor may focus in the self-actualisation aspect of the criteria

Means that ideal mental health provides a checklist against which we can assess ourselves and others and discuss psychological issues with a range of professionals

Takes a HOLLISTIC approach to define abnormality rather than focusing on just one key characteristic

Question 15

Deviation from ideal mental health as a definition of abnormality may be CULTURE BOUND - state whether this is a strength or a weakness and explain why

Answer 15

WEAKNESS

Ideal mental health criterion’s different elements are not equally applicable across a range of cultures

Some of Jahoda’s criteria for ideal mental health are firmly located in the context of the US and Europe generally (i.e. heavily leans towards an INDIVIDUALIST mindset)

In particular, concept of self-actualisation would probably be dismissed as self-indulgent or selfish in particular COLLECTIVIST cultures rather than being a sign of ideal mental health

Even within Europe there is quite a bit of variation in the value placed on personal independence e.g. independence is very valuable in Germany whilst in Italy it’s not as such

Also, what defines success in our working, social and love lives is very different in a range of cultures - some aspects of the criterion are very SUBJECTIVE

Means that it is very difficult to apply the concept of ideal mental health from one culture to another - even within the culture Jahoda based the criterion on it is interpreted very differently (i.e. Europe)

Question 16

Deviation from ideal mental health as a definition of abnormality sets an extremely high standard for ‘good mental health’ - discuss this statement

Answer 16

Very few of us attain all of Jahoda’s criteria for ideal mental health

Probably none of us achieve all of them at the same time or keep them up for very long

Therefore it can be disheartening to see an impossible set of standards to live up to in order to avoid being labelled ‘abnormal’

Questionable if it is truly valid- if by definition most of the population would be classed as ‘abnormal’ due to the impossibly difficult criterion to achieve and maintain, is it even a good definition in the first place?

However, having such a comprehensive set of criteria for mental health to work towards might be of practical value to someone wanting to understand and improve their mental health

Therefore value of the definition questionable - depends on the type of person using it in the first place

Question 17

What is the DSM-5’s definition and categories of phobia?

Answer 17

• All phobias characterised by excessive fear and anxiety triggered by an object, place or situation
• Extent of the fear is disproportionate (i.e. IRRATIONAL) to any real danger proposed by the phobic stimulus

Categories of phobia and related anxiety disorder:

1. Specific phobia = phobia of an object or a situation
2. Social anxiety (social phobia) = phobia of a social situation e.g. public speaking
3. Agoraphobia = phobia of being outside or in a public space

Question 18

What are the behavioural characteristics of phobias?

Answer 18

1. Panic
2. Avoidance
3. Endurance

Question 19

Describe ‘panic’ as a behavioural characteristic of phobias

Answer 19

• Person with phobia may panic in response to presence of the phobic stimulus
• Involves range of behaviours e.g. crying, screaming or running away
• Children mat behave slightly differently e.g. freezing, crying or having a tantrum

Question 20

Describe ‘avoidance’ as a behavioural characteristic of phobias

Answer 20

• Unless person is making a conscious effort to face their fear they tend to put a lot of effort in preventing contact with the phobic stimulus
• Avoidance can make it difficult for a person’s daily life depending on the phobia
• E.g. someone with a fear of the sun may avoid going outside or opening their curtains - makes it difficult for work life and social life
• Avoidance can interfere with work, education and social life

Question 21

Describe ‘endurance’ as a behavioural characteristic of phobias

Answer 21

• Alternative behavioural response to avoidance is endurance
• Occurs when the person chooses to remain in the presence of the phobic stimulus
• E.g. a person with arachnophobia might choose to remain in the room with a spider, but will instead pay extreme attention to it rather than leaving

Question 22

What are the emotional characteristics of phobias?

Answer 22

1. Anxiety
2. Fear
3. Emotional response is unreasonable

Question 23

Describe ‘anxiety’ as an emotional characteristic of phobias

Answer 23

• Phobias classed as anxiety disorders
• By definition involve an emotional response of anxiety i.e. an unpleasant state of high arousal
• Prevents a person relaxing
• Makes it very difficult to experience any positive emotion
• Anxiety can be long term

Question 24

Describe ‘fear’ as an emotional characteristic of phobias

Answer 24

• Fear = the immediate and extremely unpleasant response experienced when encountering or thinking of the phobic stimulus
• Usually more intense but experienced for shorter periods of time compared to anxiety

Question 25

Describe ‘emotional responses being unreasonable’ as an emotional characteristic of phobias

Answer 25

• Anxiety or fear is much greater than what is considered ‘normal’
• Response disproportionate to the real threat posed by the phobic stimulus
• Response is irrational when compared to the reaction a person without a phobia has to the phobic stimulus

E.g. a person with arachnophobia may experience extreme fear when in the presence of even a small spider - this fear seems irrational and unreasonable when we compare it to the reaction a person who doesn’t have arachnophobia

Question 26

What are the cognitive characteristics of phobias?

Answer 26

1. Selective attention to the phobic stimulus
2. Irrational beliefs
3. Cognitive distortions

Question 27

Describe ‘selective attention to the phobic stimulus’ as a cognitive characteristic of phobias

Answer 27

• If a person can see the phobic stimulus it is hard to look away from it
• Keeping our attention on something dangerous is a good thing when reacting quickly to a threat, however it is not so useful when this fear is irrational

E.g. a person with arachnophobia will struggle to concentrate when they notice a spider in the room - attention is unnecessarily focused on the phobic stimulus

• This selective attention can affect a person’s ability to function or concentrate once in contact with the phobic stimulus

Question 28

Describe ‘irrational beliefs’ as a cognitive characteristic of phobias

Answer 28

• Person with a phobia may hold thoughts that cannot be easily explained and don’t have any basis in reality in relation to phobic stimuli

E.g. a person with a social phobia can have irrational beliefs such as “I must be perfect otherwise people will make fun of me”

• Beliefs may further intensify phobia or instigate further irrational thoughts
• Some people may believe that phobia is justified based on their irrational beliefs

Question 29

Describe ‘cognitive distortions’ as a cognitive characteristic of phobias

Answer 29

• Perceptions of the phobic stimuli may be inaccurate and unrealistic

E.g. someone with arachnophobia may perceive even a small spider as very large and potentially deadly when in reality this is not the case

Question 30

What are the two components of the two-process model as a behavioural approach for explaining phobias?

Answer 30

• Phobias are acquired (i.e. learned) by classical conditioning
• Phobias are maintained by operant conditioning
• Created by Mowrer (1960)

Question 31

Describe ‘acquisition by classical conditioning’ as a behavioural approach for explaining phobias. Include any relevant research

Answer 31

• Involves learning to associate something of which we initially have no fear (neutral stimulus) with something that already triggers an innate fear response (unconditioned stimulus)

      Watson and Rayner (1920) studied how phobias can be created via classical conditioning:

• Created a phobia in a 9-month old baby called “Little Albert”
• Albert showed no usual anxiety to neutral stimulus (a white rat) at start of study (NS)
• However, to create this phobia whenever the rat was presented to Albert the researchers made a loud, frightening noise by banging an iron bar close to his ear
• Noise = unconditioned stimulus (UCS), which produced and unconditioned response (UCR) of fear
• When NS (rat) and the UCS are encountered close together in time Albert began to associate these two stimuli together where both began to trigger the fear response
• Albert began to display fear when seeing the rat - the rat became the conditioned stimulus (CS) that produced the conditioned response of fear (CR)
• Conditioning then became GENERALISED to similar objects
• E.g. they tested Albert by showing him other furry objects such as a non-white rabbit and a fur coat - little Albert showed the same levels as distress as the CS

Question 32

Describe ‘maintenance by operant conditioning’ as a behavioural approach for explaining phobias

Answer 32

• Responses acquired by classical conditioning usually tend to decline over time
• However, phobias are often long-lasting due to operant conditioning
• Operant conditioning takes place when our behaviour is reinforced (rewarded) or punished
• Reinforcement tends to increase the frequency of behaviour and can be applied to both positive and negative reinforcement
• In negative reinforcement an individual avoids a situation that is unpleasant - such behaviour results in a desirable consequence (i.e. not coming into contact with the phobic stimulus) which means behaviour is repeated
• Mowrer suggested that whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that would be experienced if we remained there
• Reduction in fear reinforces the avoidance behaviour and so the phobia is maintained

Question 33

The two-process model has real life application as a behavioural explanation for phobias - state whether this is a strength or a weakness and explain why

Answer 33

STRENGTH

Has real world application in exposure therapies (e.g. systematic desensitisation and flooding)

Distinctive element of two-process model is the idea that phobias are maintained by avoidance of the phobic stimulus

This element important in explaining why people with phobias benefit from being exposed to the phobic stimulus

Once the avoidance behaviour is prevented it ceases to be reinforced by the experience of anxiety reduction and avoidance therefore declines

In behavioural terms the phobia is the avoidance behaviour so when this avoidance is eventually fully prevented the phobia is considered ‘cured’

This shows the value of the two-process approach because it identifies a means of treating phobias - has real life application with a positive effect for society as a whole

Question 34

The two-process model as a behavioural explanation for phobias fails to take into account the cognitive aspects of the disorder - state whether this is a strength or a weakness and explain why

Answer 34

WEAKNESS

Behavioural explanations (including the two-process model) only focus on the behavioural characteristics of phobias - particularly avoidance of the phobic stimulus

However we know that phobias are not simply avoidance responses - they also have a significant cognitive element e.g. irrational beliefs about the phobic stimulus

The two-process model explains avoidance behaviour but does not offer an adequate explanation for phobic cognitions - therefore theory is REDUCTIONIST when explaining phobias

Means that the two-process model only explains the symptoms of phobias up to an EXTENT i.e. it is only a partial explanation for phobias

Question 35

There is research support for the link between bad experiences and phobias - state whether this is a strength or a weakness of the two-process model as a behavioural explanation for phobias and explain why

Answer 35

STRENGTH

Little Albert study illustrates how a frightening experience involving a stimulus can classically condition a phobia of that stimulus

More systematic evidence comes from study by Jongh et al (2006):

• Found that 73% of people with a fear of dental treatment had experienced a traumatic experience, mostly involving dentistry
• Others with this phobia had experienced being a victim of a violent crime
• Association between dentistry and traumatic experience led to classical conditioning and development of the phobia
• Compared to control group of people with low dental anxiety, only 21% had experienced a traumatic event

Multiple sources of research evidence conforms that the association between a neutral stimulus (e.g. dentistry) and an unconditioned response (e.g. pain) does lead to the development of a phobia, as the theory suggests

Question 36

Some psychologists argue that not all phobias appear following a bad experience - state whether this is a strength or a weakness of the two-process model as a behavioural explanation for phobias and explain why

Answer 36

WEAKNESS (COUNTERPOINT to research evidence for link between negative experience and phobia argument)

Argued that some common phobias e.g. phobia of snakes occur in populations where very few people have any experience of snakes let alone traumatic ones

Also, considering the other direction, not all frightening experiences lead to phobias (i.e. association between the neutral stimulus and unconditioned response does not always occur)

Means that the association between phobias and frightening experiences is not as strong as we would expect if behavioural theories provided a complete explanation for phobias

Yet again, the two process model only explains phobias up to an EXTENT - classical conditioning to create a phobia is not guaranteed just because an unconditioned response is stimulated like the theory suggests

Question 37

There is debate between the two-process model as a behavioural explanation for phobias and the influence of evolution - discuss these viewpoints

Answer 37

Behavioural models of phobias (e.g. the two process model) provide credible individual explanations

I.e. they can explain how a particular person develops and maintains a particular phobia

However, there are more general aspects to phobias that may be better explained by evolutionary theory

E.g. we tend to acquire phobias of things that have presented a danger in our evolutionary past e.g. snakes

Seligman (1971) described this as PREPAREDNESS

Means that there may be a wider discussion in terms of nature vs nurture when explaining phobias - behavioural explanations are just one side of this debate

Question 38

What are the three processes of systematic desensitisation (SD) and which mental disorder does it treat?

Answer 38

1. The anxiety hierarchy
2. Relaxation
3. Exposure

• Aims to treat phobias by the process of classical conditioning
• New response to phobic stimulus is learned (i.e. conditioned response changed from anxiety to relaxation)
• Process of creating a different conditioned response = COUNTERCONDITIONING

Question 39

Describe the first process in systematic desensitisation when treating phobias

Answer 39

1. The anxiety hierarchy:

• Put together by a client with a phobia and the therapist
• List of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening

E.g. someone with arachnophobia might identify a picture of a small spider as low on their anxiety hierarchy and holding a tarantula at the top of their hierarchy

Question 40

Describe the second process in systematic desensitisation when treating phobias

Answer 40

2. Relaxation:

• Therapist teaches client to relax as deeply as possible
• Impossible to be afraid and relaxed at the same time, so one emotion prevents the other = known as RECIPROCAL INHIBITION
• Relaxation might involve breathing exercises or mental imagery techniques

E.g. clients can be taught to imagine themselves in relaxing situations like lying on the beach or they might learn meditation

• Relaxation can also be achieved via. drugs e.g. Valium

Question 41

Describe the third process in systematic desensitisation when treating phobias

Answer 41

3. Exposure :

• Finally client is exposed to phobic stimulus when in a relaxed state
• Takes place over several sessions, starting at the bottom of the anxiety hierarchy
• When client can consistently stay relaxed in the presence of the lower levels of the phobic stimulus they move up the hierarchy
• Treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy

Question 42

There is research evidence for the effectiveness of systematic desensitisation - state whether this is a strength or a weakness and explain why

Answer 42

STRENGTH

Gilroy et al (2003):

• Followed up 42 people who had SD for arachnophobia in 3 45-minute sessions (total of 2hrs 15mins)
• At both 3 + 33 months, the SD group were less fearful than a control group treated by relaxation without exposure (i.e. without all 3 elements of SD)

In a recent review Wechsler et al (2019) concluded that SD is effective for social phobia + agoraphobia

Research support for treatment suggests that SD is likely to be helpful and effective for people with phobias

Question 43

It is arguable that research into systematic desensitisation’s effectiveness only accounts for a small proportion of phobias - state whether this is a strength or a weakness and explain why

Answer 43

WEAKNESS (COUNTERPOINT to research support)

Cannot generalise research support to all phobias

Just because SD has research support for being effective against arachnophobia and agoraphobia doesn’t necessarily mean that it would work for others e.g. xanthophobia (fear of colour yellow)

Research into phobias hard to come by, with only 2% of UK population with phobia

Therefore, research support for SD (especially for the more niche phobias) would be extremely rare

Therefore we cannot conclude the SD is effective against all phobias, rather there has been research support for it being effective against SOME phobias, particularly the more ‘common’ ones

Means that research support for SD is still lacking - mainly due to the rarity of phobias themselves

Question 44

Systematic desensitisation can be used to treat a wider demographic of those with phobias when compared to other treatments - state whether this is a strength or a weakness and explain why

Answer 44

STRENGTH

One of the most INCLUSIVE treatments as it takes into account those with learning disabilities

Significant proportion of those with phobias also have a learning disability

However main alternatives - mainly cognitive therapies - not suitable for these people

People with learning disabilities often struggle with cognitive therapies which require complex rational thought

May also feel confused and distressed by traumatic experience of flooding - in most severe cases person may not even have the mental capacity to give fully informed consent to such a traumatic treatment

Instead SD takes a more slow and gentle approach much more preferable to these people

Means that SD is the most inclusive and appropriate treatment for a significant proportion of those who have phobias as the barrier of entry is not very high

Question 45

Some psychologists would like to modernise systematic desensitisation as a treatment for phobias by integrating it with virtual reality - discuss this viewpoint

Answer 45

Traditional SD involves exposure to phobic stimulus in a real-world setting

However argued that there are advantages to conducting the exposure part of SD in VR

E.g. exposure through VR can be used to avoid dangerous situations e.g. heights + is cost-effective because the psychologist and client do not have to leave the consulting room

Important for treatments to be flexible in a world where technological advancements are rapid - integrating SD to VR is an example of adaptation to modern society

However, evidence from some psychologists suggesting that VR exposure may be less effective than real exposure for social phobias because it lacks realism (Wechsler et al, 2019)

Perhaps integrating SD with VR may be more effective for some phobias over others

Question 46

What is flooding and how does it work? Which mental disorder does flooding treat?

Answer 46

• Treats phobias
• Involves exposing people to phobic stimulus without any gradual build-up in an anxiety hierarchy
• I.e. involves immediate exposure to a very frightening situation
• Sessions typically longer than SD sessions, sometimes only one long session necessary to cure a phobia
• Flooding stops phobic responses very quickly by removing the option of avoidance behaviour
• Taking away the option to avoid the phobic stimulus helps client quickly learn that it is actually harmless - known as EXTINCTION in classical conditioning terms
• Conditioned response quickly EXTINGUISED when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten)
• Result is that the conditioned stimulus no longer produces a conditioned response (e.g. fear) because the ASSOCIATION between the CS and UCS is quickly extinguished through removing avoidance behaviour
• In some case client may achieve relaxation in presence of phobic stimulus due to EXHAUSTION by their own fear response

Question 47

Describe the ethical safeguards put in place when treating a phobia using flooding

Answer 47

• Flooding not exactly unethical if precautions made to receive fully informed consent - even if the experience is very distressing
• Client made sure to be fully prepared before flooding sessions
• Client normally given choice between systematic desensitisation and flooding

Question 48

Flooding may be the most cost-effective treatment for phobias - state whether this is a strength or a weakness and explain why

Answer 48

STRENGTH

Flooding both clinically effective and inexpensive - therefore favoured treatment in large health organisations e.g. NHS

Flooding can work in as little as one session as opposed to ten sessions that SD would need to achieve the same result - allows for a greater proportion of clients to be treated within the same timeframe

Even with longer flooding sessions ( approx. 3hrs) this still makes it more cost-effective than other treatments

Means that more people can be treated at the same cost and within the same amount of time with flooding that with SD or other therapies + can be used effectively in health organisations like the NHS

Question 49

Even though fully informed consent is given, flooding is arguably one of the most traumatic and unpleasant treatments for phobias - state whether this is a strength or a weakness and explain why

Answer 49

WEAKNESS

Flooding is a highly unpleasant and traumatic experience

Confronting ones phobic stimulus in an extreme form provokes tremendous anxiety

Schumacher et al (2015) = found that ppts and therapists rated flooding as significantly more stressful than SD

Raises the ethical issue for psychologists knowingly causing stress to their clients even with the obtained informed consent

In technicality informed consent gives the therapist permission to elicit this extreme fear response under the pretence of treatment - however in terms of morality is this correct? - How far should one go to be treated and how much further will we go from flooding if we find it more effective?

Traumatic nature means that ATTRITION rates are higher than for SD - puts into question true cost-effectiveness of SD

Suggests that, overall, therapists may avoid using flooding as the first line for treating phobias

Question 50

Some psychologists argue that behavioural treatments for phobias only mask symptoms and do not tackle the underlying causes of them - discuss this argument

Answer 50

Argued that behavioural therapies, including flooding, only masks symptoms rather than tackling the underlying causes of phobias (SYMPTOM SUBSTITUTION)

Persons (1986):

• Reported the case of a woman with a phobia of death who was treated using flooding
• Her fear of death declined, but her fear of being criticised got worse

However, only evidence for symptom substitution comes in the form of case studies which may only generalise to the phobias in said study (e.g. phobia of death may differ from a phobia of heights)

Does it even matter if symptom substitution happens with these treatments in the first place? If a person with a phobia is able to live their ordinary life because of these therapies then hasn’t it done its job? Do technicalities like these truly matter if the outcome is virtually the same?

Question 51

What is the DSM-5’s definition and categories of depression?

Answer 51

• Depression = mental disorder characterised by low mood and/or loss of interest or pleasure in activities
• Individual must have 5 or more recognised symptoms of depression within the same 2-week period

Categories of depression based on duration and severity:

1. Major depressive disorder = severe but often short-term depression
2. Persistent depressive disorder = long-term or recurring depression, including sustained major depression (also known as DYSTHYMIA)
3. Disrupted mood dysregulation disorder = childhood temper tantrums
4. Premenstrual dysphoric disorder = disruption to mood prior to and/or during menstruation

Question 52

What are the behavioural characteristics of depression?

Answer 52

1. Changed activity levels
2. Disruption to sleep and eating behaviour
3. Aggression and self-harm

Question 53

Describe ‘changed activity levels’ as a behavioural characteristic of depression

Answer 53

• Often lethargic due to reduced energy levels
• Has knock-on effect e.g. withdrawing from work, education and social life
• In extreme cases can be so severe that the person cannot get out of bed
• Some cases depression can have the opposite effect = known as PSYCHOMOTOR AGITATION
• Agitated individuals struggle to relax and may end up pacing up and down a room

Question 54

Describe ‘disruption to sleeping and eating behaviour’ as a behavioural characteristic of depression

Answer 54

• Person may experience reduced sleep (i.e. insomnia), particularly premature waking
• Others may experience and increased need for sleep i.e. hypersomnia
• Similarly appetite may increase or decrease, leading to drastic weight gain or loss
• Such behaviours are disrupted by depression

Question 55

Describe ‘aggression and self-harm’ as a behavioural characteristic of depression

Answer 55

• Often irritable
• In some cases can become verbally or physically aggressive
• Aggression can have serious knock-on effects on different aspects of life

E.g. someone experiencing depression may display verbal aggression by ending a relationship harshly

• Can also lead to physical aggression directed against the self e.g. self-harm
• Self-harm often in the form of cutting or suicide attempts

Question 56

What are the emotional characteristics of depression?

Answer 56

1. Lowered mood
2. Anger
3. Lowered self-esteem

Question 57

Describe ‘lowered mood’ as an emotional characteristic of depression

Answer 57

• More to clinical depression that just having a lowered mood
• Lowered mood still a defining emotional element of depression but is more pronounced than in the daily kind of experience of feeling lethargic + sad
• People with depression have an extremely lowered mood to the point where they feel ‘worthless’ and ‘empty’

Question 58

Describe ‘anger’ as an emotional characteristic of depression

Answer 58

• Negative emotions experienced by depressed is not just sadness, it extends to anger
• Depressed often experience anger, sometimes extreme anger
• Anger can be directed at the self or at others
• On occasion such emotions lead to aggressive or self-harming behaviour

Anger = the emotion
Aggression = the actions/behaviour as a result of these emotions

Question 59

Describe ‘lowered self-esteem’ as an emotional characteristic of depression

Answer 59

• Self-esteem = the emotional experience of how much we like ourselves
• Depressed tend to have reduced self-esteem i.e. they like themselves less than usual
• Can be quite extreme, some depressed describing a sense of self-loathing i.e. hating themselves

Question 60

What are the cognitive characteristics of depression?

Answer 60

1. Poor concentration
2. Attending to and dwelling on the negative
3. Absolutist thinking

Question 61

Describe ‘poor concentration’ as a behavioural characteristic of depression

Answer 61

• Person may find themselves unable to stick with a task they usually would
• Might find it hard to make decisions that they would normally find straightforward
• Poor concentration and decision making often interferes with individual’s work and education

Question 62

Describe ‘attending to and dwelling on the negative’ as a behavioural characteristic of depression

Answer 62

• Depressed are inclined to pay more attention to negative aspects of a situation and ignore the positives i.e. pessimistic thinking
• Depressed often have a bias to recalling unhappy events rather than happy ones (opposite bias that most people have when not depressed)

Question 63

Describe ‘absolutist thinking’ as a behavioural characteristic of depression

Answer 63

• Tend to view the world in black and white
• Only view situations at the absolute extremes (such as jumping to conclusions)

E.g. when something minor goes wrong the depressed tend to view it as an absolute disaster

Question 64

What are the three features of cognitive vulnerability in Beck’s cognitive explanation for depression?

Answer 64

Beck believed that a person’s cognitions creates a vulnerability to depression:

1. Faulty information processing
2. Negative self-schema
3. The negative triad

Question 65

Describe ‘faulty information processing’ as part of the cognitive vulnerability explanation for depression

Answer 65

• Depressed attend to the negative aspects of a situation and ignore the positives

E.g. if a depressed person won £1 million in the lottery, instead of being happy with the fact that they won a huge sum of money they would focus on the fact that the previous week someone won £10 million

• Depressed people may tend towards ‘black and white’/ absolutist thinking where something is either all good or all bad

Question 66

Describe the ‘negative self schema’ as part of the cognitive vulnerability explanation for depression

Answer 66

• Schema = mental representation of ideas and info developed through experience
• Acts as a mental framework for the interpretation of sensory info
• Self-schema = package of information people have about themselves
• People use schema to interpret the world, so if person has a negative self-schema they interpret all info about themselves in a negative way

Question 67

Describe ‘Beck’s negative triad’ as part of the cognitive vulnerability explanation for depression

Answer 67

• Beck suggested that a person develops a dysfunctional view of themselves because of the 3 types of negative thinking
• Negative thinking occurs automatically, regardless of the reality of what is happening at the time
• 3 types of negative thinking forms a triad, when person is depressed, negative thoughts about the world, the future and oneself are uppermost:

1. Negative view of the world = creates an impression that there is no hope anywhere e.g. “the world is only a cruel place”
2. Negative view of the future = such thoughts reduce any hopefulness and increase depression e.g. “there isn’t much chance that they economy will really get better”
3. Negative view of the self = Such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low SELF-ESTEEM e.g. “I am nothing but a failure”

Question 68

Beck’s cognitive model of depression has research support for its existence - state whether this is a strength or a weakness and explain why

Answer 68

STRENGTH

‘Cognitive vulnerability’ = refers to ways of thinking that may PREDISPOSE a person to becoming depressed e.g. faulty info processing, negative self-schema + negative triad

In a review Clark + Beck (1999) concluded that not only were these cognitive vulnerabilities more common in depressed people but they PRECEDED the depression

Review confirmed in more recent PROSPECTIVE study by Cohen et al (2019):

• Tracked development of 473 adolescents, regularly measuring cognitive vulnerability
• Found that showing cognitive vulnerability predicted later depression in these adolescents

Supporting research further confirms association between cognitive vulnerability + depression

Question 69

Beck’s cognitive model of depression has real world application - state whether this is a strength or a weakness and explain why

Answer 69

STRENGTH

Applications in screening and treatment for depression

Cohen et al (2019):

• Tracked development of 473 adolescents, regularly measuring cognitive vulnerability
• Found that showing cognitive vulnerability predicted later depression in these adolescents
• Concluded that assessing cognitive vulnerability allows psychologists to screen young people, identifying those most at risk of developing depression + monitoring them

Understanding cognitive vulnerability can also be applied to CBT

Therapies work by altering the cognitions that make someone vulnerable to depression, making them more resilient to negative life events

Means that understanding cognitive vulnerability is useful in multiple aspects of clinical practice

Valuable real world practical application with positive implications to society

Question 70

Some psychologists argue that Beck’s cognitive model of depression is only a partial explanation for the mental disorder - discuss this viewpoint

Answer 70

Beck’s cognitive model at least a partial explanation for depression

Little debate on the fact that depressed people show particular pattens of cognition which can be seen before the onset of depression

However, some argue that there are aspects to depression that are not particularly well explained by cognitive explanations

E.g. Some depressed people feel extreme anger, and some experience hallucinations + delusions

Therefore arguable that theory is REDUCTIONIST - only focuses on the cognitive aspect of depression whilst ignoring its other characteristics

Therefore only explains depression to an extent

Question 71

What are the three components of Ellis’s ABC model as a cognitive explanation for depression

Answer 71

1. Activating event
2. Beliefs
3. Consequences

Question 72

Describe Ellis’s ABC model as a cognitive explanation for depression

Answer 72

• Ellis proposed that good mental health is the result of rational thinking
• Depression and anxiety result from irrational thoughts
• Defined irrational thoughts as = not illogical or unrealistic thoughts, but as any thoughts that interfere with us being happy and free from pain

1. Activating event :

• Irrational thoughts triggered by negative events which results in depression

E.g. failing a test may trigger irrational beliefs which then lead to a person developing depression

2. Beliefs :

• Ellis identified range of irrational beliefs
• Musturbation = the belief that we must always succeed or achieve perfection
• “I-cant-stand-it-itis” = the belief that it is a major disaster whenever something does not go smoothly
• Utopianism = the belief that life is always meant to be fair

3. Consequences :

• When an activating event triggers irrational beliefs there are emotional and behavioural consequences

E.g. if a person believes that they must always succeed and then fail something it may trigger depression

Question 73

Ellis’s ABC model as a cognitive explanation for depression has real world application - state whether this is a strength or a weakness and explain why

Answer 73

STRENGTH

Has real world application in the psychological treatment of depression

Ellis’ approach to cognitive therapy = ‘rational emotive behavioural therapy’ (REBT)

Idea of REBT is to challenge and then rigorously argue the depressed person’s irrational beliefs

Doing this can alter the irrational beliefs that are making them unhappy

Some evidence to support idea that REBT can both change negative beliefs and relieve symptoms of depression (David et al, 2018)

Means that ABC model has real world value in depression treatment - theory can help positively impact society

Question 74

Ellis’s ABC model as a cognitive explanation for depression only explains REACTIVE depression whilst failing to address ENDOGENOUS depression - state whether this is a strength or a weakness and explain why

Answer 74

WEAKNESS

Reactive depression = depression triggered by life events (i.e. what Ellis would call ‘activating events’)

How we respond to negative life events also seems to be at least partly the result of our beliefs - therefore Ellis’ model does fit with this type of depression

However, many cases of depression have no traceable obvious cause and are not triggered by ‘activating events’ - known as ENDOGENOUS depression

Endogenous depression does not fit into the ABC model

Means that Ellis’ model can only explain some causes of depression and is therefore only a partial explanation - depression is not as straightforward as the model suggests

Question 75

Some psychologists argue that there is some controversy and potential ethical issues surrounding Ellis’s ABC model as a cognitive explanation for depression - discuss this viewpoint

Answer 75

ABC model controversial because it locates responsibility for depression purely with the depressed person as theory depends on the depressed person’s irrational
thoughts

Critics argue this is effectively blaming the depressed person, which would be unfair

On the other hand, provided that it is used appropriately and sensitively, the application of the ABC model in REBT model does appear to at least some depressed people more resilience and feel better

Therefore some psychologists argue that the ABC model may have to be used carefully otherwise it could do more harm then good

Question 76

Describe the two components of cognitive behaviour therapy (CBT) as a treatment for depression

Answer 76

1. Cognitive element =

• CBT begins with assessment in which client and CBT therapist work together to clarify client’s problems
• Jointly identify small goals and put together a plan to achieve them
• One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge

2. Behaviour element =

• CBT then involves working to change negative and irrational thoughts
• Tries to put more effective behaviours in place so that person can safely react to negative life events without it resulting in depression

Question 77

Describe Beck’s cognitive therapy as a treatment for depression

Answer 77

• CBT = the application of Beck’s theory of depression
• Idea behind CBT is to identify the negative triad - once identified these thoughts are identified they are challenged by the therapist (central component of CBT)
• As well as challenging thoughts directly, CBT also aims to help clients test the reality of their negative beliefs
• Client may be set homework e.g. recording how many times they visited friends - known as the ‘client as scientist method’
• Client’s homework then used as evidence by therapist to dispute the negative irrational thoughts

Question 78

Describe Ellis’s rational emotive behaviour therapy (REBT) as a treatment for depression

Answer 78

• REBT extends Ellis’ ABC model to the ABCDE model
• D = stands for dispute and E = stand for effect
• Central technique of REBT is to identify and dispute irrational thoughts

E.g. client might talk about how unfair things seem - REBT therapist would identify this as an example of Utopianism and challenge this as an irrational belief

• Challenging belief involves rigorous argument - the hallmark of REBT
• Intended effect is to change the irrational belief and so break the link between negative life events (i.e. ‘activating events’) and depression
• Ellis identified different methods of disputing e.g:

1. Empirical argument = involves disputing whether there is actual evidence to support the negative belief
2. Logical argument = involves disputing whether the negative thought logically follows from the facts

Question 79

Describe the ‘behavioural activation’ aspect of cognitive behaviour therapies for depression

Answer 79

• As individuals become more depressed, they tend to increasingly avoid difficult situations and become isolated - maintains or worsens symptoms
• Goal of behavioural activism is to work with depressed to gradually decrease their avoidance and isolation
• Also tries to increase engagement in activities that have been shown to improve mood e.g. exercising
• Therapist aims to enforce positive activities and slowly stop isolation + avoidance

Question 80

There is research evidence for the effectiveness of cognitive behaviour therapies as a treatment for depression - state whether this is strength or a weakness and explain why

Answer 80

STRENGTH

Large body of evidence supporting its effectiveness for treating depression

E.g. March et al (2007):

• Compared CBT to antidepressant drugs and also combination of both
• Followed treatment of 327 depressed adolescents
• After 36 weeks = 81% of CBT group, 81% of antidepressant group and 86% of the CBT plus antidepressant group had significantly improved
• Therefore CBT just as effective as antidepressants, and even more effective in combination

CBT is usually brief therapy requiring 6-12 sessions therefore arguably cost-effective when treatment is successful

Means that CBT widely seen as first choice of treatment in public health systems like the NHS - real life practical applications with positive economic outcomes for society

Question 81

Cognitive behaviour therapies as a treatment for depression may not be suitable for a diverse range of clients (i.e. not very inclusive) - state whether this is a strength or a weakness and explain why

Answer 81

WEAKNESS

Evidence suggests lack of effectiveness for severe cases and for clients with learning disabilities

In some cases depression can be so severe that clients cannot motivate themselves to engage with the cognitive work in CBT - may not even be able to pay attention

Also seems like complex rational thinking involved makes it unsuitable for treating depressed clients with learning disabilities

Sturmey (2005) = suggest that, in general, any form of psychotherapy is not suitable for people with learning disabilities - includes CBT

Means that the bar of entry for CBT may be too high for a significant proportion of those who arguably need treatment the most (i.e. the severely depressed)

Treatment only appropriate for a specific range of people with depression

Question 82

There has been recent research evidence that challenges the argument that cognitive behaviour therapies as a treatment for depression are not suitable for a diverse range of clients - state whether this is a strength or a weakness and explain why

Answer 82

STRENGTH (COUNTERPOINT to lack of suitability for diverse clients argument)

Although conventional wisdom has been that CBT is unsuitable for the very depressed and those with learning disabilities, there is recent evidence to challenge this

Review by Lewis and Lewis (2016) = concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression

Another review by Taylor et al (2008) = concluded that, when used appropriately, CBT is effective for those with learning disabilities

Means that CBT may be more inclusive than was once thought

Question 83

Cognitive behaviour therapies as a treatment for depression has high relapse rates - state whether this is a strength or a weakness and explain why

Answer 83

WEAKNESS

Although CBT is quite effective in tackling symptoms of depression, there are concerns over how long benefits last

Relatively few early studies of CBT for depression looked at long-term effectiveness

More recent studies suggest long-term outcomes of CBT are not as good as had been assumed

Ali et al (2017) =

• Assessed depression in 439 clients every month for 12 months following a course of CBT
• 42% of clients relapsed into depression within 6 months of ending treatment
• 53% relapsed in a year (over half)

Means that CBT may need to be repeated periodically - therefore CBT cannot really be considered a real “treatment”, rather it mitigates depression symptoms for a duration of time

Repeated sessions means that CBT may not be as cost-effective as once thought, perhaps systems like the NHS need to rethink their stance on the treatment and consider other options (like antidepressants)

Question 84

Surveys into cognitive behavioural therapy as a treatment for depression have shown that it is the least preferred psychological therapy - state whether this is a strength or a weakness and explain why

Answer 84

WEAKNESS

Not all clients want to tackle their depression by the methods presented by cognitive behavioural therapies

Some people want their symptoms gone as quickly as possible and prefer medication

CBT takes time and is quite disruptive - client has to take time out of their day to attend regular sessions and may even have to complete homework after - for the depressed who usually lack motivation anyways this can be incredibly difficult

Others, e.g. survivors of trauma, wish to explore the origins of their symptoms

Yrondi et al (2015) = found that depressed people rated CBT as their least preferred psychological therapy

Therefore even if CBT has evidence for its effectiveness, at least in the short term, what’s the point if the people it’s trying to treat don’t want to take this form of treatment in the first place?

Does CBT truly have any value if (most of the time) other treatments will be picked over it? What’s the point of a treatment if no one will take it?

Question 85

What are the DSM-5’s definition and categories of Obsessive-compulsive disorder (OCD)

Answer 85

• OCD = Presence of obsessions, compulsions, or both
• Obsession is cognitive whereas compulsions are behavioural

Categories of OCD (all have repetitive behaviour accompanied by obsessive thinking):

1. OCD = characterised by either obsessions and/or compulsions. Most with diagnosis of OCD have both obsessions and compulsions
2. Trichotillomania = compulsive hair pulling
3. Hoarding disorder = the compulsive gathering of possessions and the inability to part with anything, regardless of its value
4. Excoriation disorder = compulsive skin picking

Question 86

What are the behavioural characteristics of OCD?

Answer 86

1. Compulsions being repetitive
2. Compulsions reducing anxiety
3. Avoidance

Question 87

Describe “compulsions being repetitive” as a behavioural characteristic of OCD

Answer 87

• Typically those with OCD feel compelled to repeat a behaviour e.g. handwashing
• Other common compulsions = counting, praying and tidying/ordering groups of objects
• These compulsions are repeated over and over again

Question 88

Describe “compulsions reducing anxiety” as a behavioural characteristic of OCD

Answer 88

• Around 10% with OCD show compulsive behaviour alone i.e. they have no obsessions, just a sense of irrational anxiety
• For vast majority (i.e. 90%) compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions

E.g. compulsive handwashing is carried out as a response to an obsessive fear of germs

• Compulsion checking e.g. constantly checking if a door is locked, is in response to obsessive thought that it might have been left unlocked

Question 89

Describe “avoidance” as a behavioural characteristic of OCD

Answer 89

• Those with OCD often display avoidance as they attempt to reduce anxiety by keeping away from situations that can trigger it

E.g. people who handwash compulsively may avoid coming into contact with germs by wearing gloves

• However this avoidance can lead to people avoiding very ordinary situations e.g. emptying rubbish bins because of obsessive fear of germs
• Therefore avoidance can interfere with person’s daily life

Question 90

What are the emotional characteristics of OCD?

Answer 90

1. Anxiety and distress
2. Accompanying depression
3. Guilt and disgust

Question 91

Describe “anxiety and distress” as an emotional characteristic of OCD

Answer 91

• OCD regarded as unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions
• Obsessive thoughts are unpleasant and frightening
• Anxiety that accompanies obsessions can be overwhelming
• The urge to repeat a behaviour (i.e. a compulsion) creates anxiety

Question 92

Describe “accompanying depression” as an emotional characteristic of OCD

Answer 92

• OCD often accompanied by depression, so anxiety experienced can be accompanied by low mood and lack of enjoyment in activities
• Compulsive behaviour tends to bring some relief from symptoms but this is temporary

Question 93

Describe “guilt and disgust” as an emotional characteristic of OCD

Answer 93

• OCD can also involve other negative emotions like irrational guilt (e.g. over minor moral issues)
• Can also experience disgust which may be directed against something external (e.g. dirt) or at the self

Question 94

What are the cognitive characteristics of OCD?

Answer 94

1. Obsessive thoughts
2. Cognitive coping strategies
3. Insight into excessive anxiety

Question 95

Describe “obsessive thoughts” as a cognitive characteristic of OCD

Answer 95

• Around 90% of those with OCD have obsessive thoughts - a major cognitive aspect of their condition
• Vary considerably from person to person but are always unpleasant

E.g. recurring worries of being contaminated by germs or the constant thought that a door has been unlocked and intruders will come through

• Obsessive thoughts can also include hurting others

Question 96

Describe “cognitive coping strategies” as a cognitive characteristic of OCD

Answer 96

• Some adopt cognitive coping strategies to deal with obsessions

E.g. a religious person tormented by obsessive guilt may respond by praying or meditating

• Can help manage anxiety but can make person appear abnormal to others
• Strategies can also distract them from everyday tasks

Question 97

Describe “insight into excessive anxiety” as a cognitive characteristic of OCD

Answer 97

• People with OCD are generally aware that their obsessions and compulsions aren’t rational
• Self-awareness necessary for OCD diagnosis according to DSM-5

E.g. if someone really believed their obsessions were based on reality that would be a symptom of a different mental disorder, not OCD

• However, despite insight those with OCD experience catastrophic thoughts about the worse case scenarios that might result if their anxieties were justified
• Also tend to be HYPERVIGILANT i.e. they maintain constant alertness and keep attention focused on potential hazards - can be mentally taxing and physically exhausting

Question 98

What are the four main components of the genetic explanation for OCD?

Answer 98

1. Diathesis-stress model
2. Candidate genes
3. OCD being polygenic
4. Different types of OCD

Question 99

Describe the ‘diathesis-stress model’ as a genetic explanation for OCD

Answer 99

• Certain genes can leave someone more vulnerable in terms of developing OCD (i.e. someone with this genetic disposition for OCD is more likely to develop the disorder)
• However it is not just the genes that automatically lead to OCD development
• This genetic vulnerability for OCD often lays dormant until some environmental stress triggers the condition (both are necessary for development of OCD)

Question 100

Describe ‘candidate genes’ as a genetic explanation for OCD

Answer 100

• Researchers have identified genes, which create vulnerability for OCD, called candidate genes
• Some of these genes are involved in regulating the development of the serotonin system

E.g. the gene 5HT1-D beta is implicated in the transport of serotonin across synapses

Question 101

Describe ‘OCD being polygenic’ as a genetic explanation for OCD

Answer 101

• OCD not caused by one single gene but by a combination of genetic variations that together significantly increase vulnerability
• Taylor (2013) analysed findings of previous studies and found evidence that up to 230 different genes may be involved in OCD
• Genes that have been studied in relation to OCD included those associated with the action of dopamine as well as serotonin
• Both neurotransmitters believed to have role in regulating mood

Question 102

Describe the ‘different types of OCD’ as a genetic explanation for OCD

Answer 102

• One group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person
• Therefore OCD is AETIOLOGICALLY HETEROGENOUS i.e. the origins (aetiology) of OCD vary from one person to another (heterogenous)
• Also some evidence to suggest that different types of OCD may be the result of particular genetic variations e.g. hoarding disorder

Question 103

The genetic explanation for OCD has a strong evidence base - state whether this is a strength or a weakness and explain why

Answer 103

STRENGTH

Evidence from a variety of sources which strongly suggest that some people are vulnerable to OCD because of their genetic make-up

E.g. Nestadt et al (2010):

• Reviewed twin studies
• Found that 68% of identical twins (monozygotic) shared OCD as opposed to 31% of non-identical (dizygotic) twins

Another source of evidence for the genetic influence on OCD is family studies

Marini and Stebnicki (2012) found that a person with a family member diagnosed with OCD is around 4x more likely to develop it as someone without it

Large body of research support suggests that OCD is somewhat genetic in it origin, like the theory suggests

Question 104

The genetic explanation for OCD fails to fully account for environmental risk factors - state whether this is a strength or weakness and explain why

Answer 104

WEAKNESS

OCD does not appear to be entirely genetic in origin and it seems that environmental risk factors can also trigger or increase the risk of developing OCD

Diathesis-stress model only small proportion of the theory and is treated almost as an afterthought in terms of the genetic explanation

Environmental factors may have a deeper root into OCD than the genetic model suggests and rather than just being a trigger for the condition, it may even be part of this ‘OCD vulnerability’ that the genetic explanation focuses on

Cromer et al (2007) = found that over half the OCD clients in their sample had experienced a traumatic event in their past - also found that OCD was more severe in people with one or more traumas

Therefore environmental risk factors may play a bigger role in a person’s disposition for OCD than the genetic explanation initially suggests

Suggests that genetic vulnerability only provides a partial explanation of OCD i.e. only explains OCD to an extent

Question 105

There has been research support for candidate genes in animal studies, however some psychologists argue that the evidence isn’t ‘valid’ - discuss these viewpoints for the genetic explanation for OCD

Answer 105

It has proved difficult to find candidate genes in humans

However, there is some evidence from animal studies that suggest that particular genes are associated with repetitive behaviours in other species like mice (Ahmari, 2016)

However, although mice and humans share some genes, psychologists argue the human mind and brain are much more complex - therefore may not be appropriate to GENERALISE from animal repetitive behaviour to human OCD

Opens up the debate on the value of animal studies as a whole in terms of furthering our understanding of human behaviour

Question 106

What are the 2 main components of the neural explanation for OCD

Answer 106

1. The role of serotonin
2. Decision making systems

Question 107

Describe the ‘role of serotonin’ as a neural explanation for OCD

Answer 107

• OCD may be involved with the neurotransmitter serotonin, which is believed to help regulate mood
• Neurotransmitters responsible for relaying info from one neuron to another
• If a person has low levels of serotonin then normal transmission of mood-relevant info does not take place and person may experience low mood
• Other mental processes may also be affected by low serotonin
• Therefore at least some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain

Question 108

Describe ‘decision making systems’ as a neural explanation for OCD

Answer 108

• Some cases of OCD, in particular hoarding disorder, seem to be associated with impaired decision making
• Impaired decision making associated with abnormal functioning of the lateral parts of the FRONTAL LOBES of the brain
• Frontal lobes responsible for logical thinking and decision making - therefore abnormalities would impair these functions
• Also evidence to suggest that an area called the LEFT PARAHIPPOCAMPAL GYRUS, associated with processing unpleasant emotions, functions abnormally in OCD

Question 109

The neural model for OCD has some research evidence - state whether this is a strength or a weakness and explain why

Answer 109

STRENGTH

Antidepressants that work purely on serotonin have been shown to be effective in reducing OCD symptoms (e.g. SSRIs)

Suggests that serotonin is involved with OCD

Nestadt et al (2010) = concluded that OCD symptoms form part of conditions that are known to be biological in origin e.g. Parkinson’s disease (degenerative brain disorder)

Therefore if a biological disorder produces OCD symptoms, we can assume that the biological processes underlie OCD

Suggests that biological factors suggested by the neural model of OCD (e.g. serotonin and the processes underlying certain disorders) may also be responsible for OCD

Means that theory is evidence-based

Question 110

Some psychologists argue that the serotonin-OCD link may not be unique to OCD - state whether this is a strength or a weakness of the neural explanation of OCD and explain why

Answer 110

WEAKNESS

Many people with OCD also experience clinical depression

Having two disorders together also known as CO-MORBIDITY

Depression also commonly associated (though not necessarily caused by) disruption to the action of serotonin

Leaves us with the logical problem when it comes to serotonin as a possible basis for OCD

It could simply be that serotonin activity is disrupted in may people with OCD because they are depressed as well, not that OCD and serotonin are directly linked

Therefore we cannot rely with this explanation alone as the OCD-serotonin link is simply speculative at best

Question 111

Some psychologists argue that the correlation presented by the neural explanation for OCD doesn’t necessarily equal causation - state whether this is a strength or a weakness and explain why

Answer 111

There is evidence to show that some neural systems (such as serotonin) do not work normally in OCD

According to the biological model of mental disorder this is most easily explained by the brain dysfunction causing the OCD

However, some psychologists argue this is simply correlation between neural abnormality and OCD and does not explain anything but point out a weak link between two variables

Correlations do not necessarily indicate a causal relationship

It is quite possible that the OCD (or its accompanying depression) causes abnormal brain function rather than the other way around or both are influenced by a third factor

Therefore brings into question if other explanations are better suited for OCD than the neural one, or if the neural one should be used in conjunction with other theories

Question 112

Describe SSRIs as a biological treatment for OCD and explain how they work in terms of synaptic transmission

Answer 112

• SSRI = selective serotonin reuptake inhibitor
• A type of antidepressant that works on the serotonin system in the brain
• Serotonin is released by the presynaptic neurons in the brain from vesicles where it travels across the synapse to stimulate receptor sites in the postsynaptic neuron
• Once receptor sites in the postsynaptic neuron has been stimulated, the serotonin is reabsorbed by the presynaptic neuron where it is broken down and reused
• However, those with OCD have abnormally functioning serotonin system where the postsynaptic neuron’s receptor sites aren’t as stimulated by serotonin
• By preventing the reabsorption and breakdown of serotonin. SSRIs effectively increase levels of serotonin in the synapse and thus continue to stimulate the postsynaptic neuron - compensates for abnormal serotonin system function
• Dosage varies according to which SSRI is prescribed

E.g. typical daily dose of FLUOXETINE is 20mg although this may be increased if it’s not benefitting the person

• Drug can be available as capsules of liquid
• Takes 3-4 months of daily use for SSRIs to have a noticeable impact on symptoms

Question 113

Describe how SSRIs as a biological treatment for OCD is combined with other treatments

Answer 113

• Drugs often used alongside CBT
• The drugs reduce a person’s emotional symptoms e.g. feeling anxious or depressed
• Means that people with OCD can engage more effectively with the CBT due to the effect of the drugs
• In practice, some respond best to CBT alone whilst others benefit when additionally using drugs like FLUOXETINE
• Occasionally other drugs are prescribed alongside SSRIs

Question 114

Describe some alternatives to SSRIs as biological treatments for OCD

Answer 114

• Where an SSRI is not effective after 3-4 months the dose can be increased (e.g. fluoxetine dose increased from 20mg to 60mg a day) or combined with other drugs
• Effectiveness of drugs depend on the person taking them - response varies from person to person
• Sometimes different antidepressants are tried e.g:

1. TRICYCLICS =

• Older type of antidepressant
• example : CLOMIPRAMINE
• Acts on various systems, including serotonin system where it has the same effect as SSRIs
• Clomipramine has more severe side-effects than SSRIs so it’s generally kept in reserve for those who don’t respond to SSRIs

2. SNRIs:

• Serotonin-noradrenaline reuptake inhibitors
• Different class of antidepressant drugs
• Used as second line of defence for those who don’t respond to SSRIs
• SNRIs increase levels of serotonin as well as a different neurotransmitter - NORADRENALINE

Question 115

Drug treatments for OCD has research evidence for its effectiveness - state whether this is a strength or a weakness and explain why

Answer 115

STRENGTH

There is clear evidence to show that SSRIs reduce symptom severity and improve the quality of life for those with OCD

Soomro et al (2009):

• Reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD
• All 17 studies showed significantly better outcomes for SSRIs than for the placebo conditions

Typically symptoms reduce for around 70% of people taking SSRIs (well over half)

For the remaining 30%, most can be helped by either alternative drugs or combinations of drugs and psychological therapies (like CBT)

Means that drugs have evidence for its effectiveness and appear to help a majority of those taking them in reducing symptoms and improving their overall life

Question 116

There is some evidence that suggests that even if drug treatments for OCD are effective, they may not be the most effective treatment available as a whole - state whether this is a strength or a weakness and explain why

Answer 116

WEAKNESS (COUNTERPOINT to research support argument)

Some evidence suggests that even if drug treatments are helpful for most with OCD, they may not be the most effective treatment available

Skapinakis et al (2016):

• Carried out a SYSTEMATIC REVIEW of outcome studies
• Concluded that both cognitive and behavioural (e.g. exposure) therapies were more effective than SSRIs in the treatment of OCD

Means that drugs, even if effective, may not be the optimum treatment for OCD - may not be the first choice in terms of the most effective for some patients

Question 117

The general consensus on drug treatments for OCD is that it is cost-effective and non-disruptive to people’s lives - state whether this is a strength or a weakness and explain why

Answer 117

STRENGTH

Drugs are relatively cheap compared to psychological treatments

Many thousands of tablets or liquid can be mass produced in the time it takes to conduct one session of psychological therapy

Therefore much more people can be treated within a given time frame with drugs than with therapies

Using drugs to treat OCD therefore good value for public health systems like the NHS and represents a good use for limited funds - helps maximum number of people with relatively little economic impact

Compared to psychological therapies, SSRIs are also non-disruptive to people’s life

Many with OCD have accompanying depression along with anxiety - taking time out of their day regularly to receive therapy may be especially difficult for these people

If a person wishes they can simply take drugs until their symptoms decline - don’t have to do anything extra or mentally draining

Means that drugs are quite popular with many people with OCD and their doctors - unintrusive and cost-efficient therefore a net positive for all those involved

Question 118

Drug treatments for OCD can have potentially serious side-effects, and have been seen in a significant proportion of those taking these medication - state whether this is a strength or a weakness and explain why

Answer 118

WEAKNESS

Although drugs like SSRIs help most people, a small minority will get no benefit

Some may also experience side effects such as: indigestion, blurred vision and loss of sex drive

These side effects usually temporary, however they can be quite distressing for people and for a minority they are long lasting

May scare off some patients from continuing treatment or starting it in the first place

For those taking the the TRICYLIC CLOMIPRAMINE side-effects are much more common and can be more serious

E.g. more than 1 in 10 (considered ‘very common’ by the World Health Organisation) people experience erection problems and weight gain

+ 1 in 100 (considered ‘common’ by the World Health Organisation) become aggressive and experience heart-related problems

These statistics would be quite alarming for who need treatment and puts into question whether it’s truly worth prescribing if these side effects are so common when other treatments are available

Means that some people have a reduced quality of life as a result of taking drugs and mat stop taking them altogether, meaning the drugs cease to be effective

Question 119

There will always be some controversy over the evidence for the effectiveness of drug treatments for OCD as some psychologists argue that the evidence is biased - discuss the different viewpoints on this statement

Answer 119

Some psychologists believe that the evidence for drug effectiveness is biased because researchers are sponsored by drug companies

Goldacre (2013) = argues that paid researchers may selectively publish positive outcomes for the drugs their sponsors are selling

Also suspicious that drugs like clomipramine, with very common (according to World Health Organisation) potentially serious side effects are still being prescribed when there are more effective treatments available (therapies, SNRIs etc.)

However, there is a lack of independent studies of drug effectiveness

Some also argue that not just drug research, but research on psychological therapies may also be biased

Most controversy is simply speculation - we cannot necessarily carry suspicion as fact

Best evidence available is supportive of the usefulness of drugs for OCD, so until concrete opposing evidence is presented we have no choice but to accept drugs as an option for treating OCD