Topic 6- Psychopathology Flashcards
Definitions for abnormality
Statistical infrequency
Failure to function adequately
Deviation from social norms
Deviation from ideal mental health
Evaluate statistical infrequency
Works well for IQ which is measured objectively, only 2% have an iq below 70 -diagnosed with intellectual disability
Assumes anyone whose behaviour differs from average is abnormal
Cut off point for normality/ abnormality is unclear
Evaluate deviation from social norms
Context - situation in which behaviour occurs (nudist beach example)
Does not offer a universal definition of abnormality (homosexuality example and African culture hearing voices)
Evaluate failure to function adequately
Personal distress for close relative is normal - abnormal not to grieve
Unclear how extreme the behaviour had to be in order to be considered abnormal
Evaluate deviation from ideal mental health
Most people don’t meet all ideals all the time
Unclear how many of the criteria need to be lacking
What systems do psychiatrists use to classifying and diagnosing mental health problems ?
DSM (diagnostic and statistical manual of mental disorder)
Current edition of DSM 5 lists about 300 disorders published in 2013
What is a phobia
An extreme, irrational fear leading to intense anxiety and avoidance of an object or situation
What are the emotional, cognitive and behavioural characteristics of a phobia?
E- produces fear that is marked, persistent, excessive and unreasonable
B- leads to avoidance of feared object (interferes with persons normal life)
C- persons thinking is irrational although generally they recognise this
What type of disorder is depression ?
Mood
What type of disorder is a phobia?
Anxiety
What type of disorder is OCD?
Anxiety
What are the emotional, behavioural and cognitive characteristics of depression?
E- sufferers are sad and may feel worthless, hopeless and experience low self esteem
B- reduced in energy/ feel tired and sleep is affected, some people sleep much more.. Some have reduced appetite and others eat considerably more than usual
C- negative thoughts about the world them self and the future - irrational do not accurately reflect reality
Emotional/ behavioural/ cognitive characteristics of OCD
E- obsessions and compulsions are a source of anxiety and distress- aware the behaviour is excessive - embarrassment and shame
B- performed to reduce the anxiety created by obsessions ( examples of ocd, avoid something dreadful happening)
C- recurrent intrusive thoughts - frightening or embarrassing
What’s within the behavioural approach to explain phobias
Classical conditioning (little Albert) Operant conditioning Treatment 1 systematic de- sensitisation Evaluation of this Treatment 2 flooding Evaluation of this
What’s within the cognitive approach in explaining depression?
Ellis's ABC model Beck's cognitive triad theory Evaluation of cognitive approach explaining depression CBT Evaluation of CBT
Outline CBT
Goal - challenge negative irrational thoughts
Based on ABC and COG triad
REBT replaces the thoughts, extends ABC model to ABCDE A=activating event B=belief C=consequences D=dispute E=effect
Logical, empirical and pragmatic disputing
Effective disputing allows person to move from catastrophising to more rational interpretations of events.
Another form of CBT is based on Becks Cog Triad- therapist identifies and challenges automatic thoughts about world, self n future -beliefs are challenged by recording occasions when people are nice to them
What does statistical infrequency suggest?
A persons trait,thinking or behaviour is classified as abnormal if it is rare or statistically unusual
What does deviation from social norms suggest?
That people who break or reject the social norms and behave in a socially deviant way should be regarded as abnormal
What does deviation from ideal mental health suggest?
The further people are from the ideals JAHODA identified, the more abnormal they are
Outline JAHODA
Identifies 6 criteria relating to ideal mental health which are required for “optimal living”
- positive attitude towards self
- potential for growth and development
- autonomy
- resistance to stress
- environmental mastery
- accurate perception of reality
What does failure to function adequately suggest?
ROSENHAN AND SELIGMAN suggested there were 6 features of abnormality. The more features present, the more abnormal an individual is.
- personal distress
- maladaptive behaviour
- unpredictability
- observer discomfort
- violation of moral and ideal standards
- irrationality
Outline Watson and Rayner
LITTLE ALBERT-caused him to have a phobia of white rats
Loud noise Fear
🔨 ➡️ 😢
UCS UCR
Loud noise White Rat Fear
🔨 ➕ 🐁 ➡️ 😢 REPEAT
UCS NS UCR
White Rat Fear
🐁 ➡️ 😢
CS CR
Fear generalised to similar objects e.g a rabbit and a fur coat
Outline operant conditioning in relation to phobias
Pos reinforcement- something pleasant.
Fam+friends give attention to someone when they show fear to object or situation, it is reinforced + behaviour is repeated
Neg reinforcement-removal of something unpleasant.
Avoid fear object or situation to remove feeling of anxiety- avoidant behaviour is repeated
What does statistical infrequency suggest?
A persons trait,thinking or behaviour is classified as abnormal if it is rare or statistically unusual
What does deviation from social norms suggest?
That people who break or reject the social norms and behave in a socially deviant way should be regarded as abnormal
What does deviation from ideal mental health suggest?
The further people are from the ideals JAHODA identified, the more abnormal they are
Outline JAHODA
Identifies 6 criteria relating to ideal mental health which are required for “optimal living”
- positive attitude towards self
- potential for growth and development
- autonomy
- resistance to stress
- environmental mastery
- accurate perception of reality
What does failure to function adequately suggest?
ROSENHAN AND SELIGMAN suggested there were 6 features of abnormality. The more features present, the more abnormal an individual is.
- personal distress
- maladaptive behaviour
- unpredictability
- observer discomfort
- violation of moral and ideal standards
- irrationality
Outline Watson and Rayner
LITTLE ALBERT-caused him to have a phobia of white rats
Loud noise Fear
🔨 ➡️ 😢
UCS UCR
Loud noise White Rat Fear
🔨 ➕ 🐁 ➡️ 😢 REPEAT
UCS NS UCR
White Rat Fear
🐁 ➡️ 😢
CS CR
Fear generalised to similar objects e.g a rabbit and a fur coat
Outline operant conditioning in relation to phobias
Pos reinforcement- something pleasant.
Fam+friends give attention to someone when they show fear to object or situation, it is reinforced + behaviour is repeated
Neg reinforcement-removal of something unpleasant.
Avoid fear object or situation to remove feeling of anxiety- avoidant behaviour is repeated
What is Systematic De-sensitisation?
A behaviour modification technique founded on the principles of classical conditioning
It reduces the learned link between anxiety and objects or situations that are typically Fear-producing
Aim-to reduce or eliminate fears that sufferers find distressing or impair their ability to manage daily life.
Counter-conditioning➡️by substituting a new response to a feared situation -a trained contradictory response of relaxation which is irreconcilable with an anxious response-phobia reactions are diminished or eradicated
Common fears which are treated
🗣🛩💃🏼🚘🐷
How does the systematic de-sensitisation treatment work?
Step one-
Taught deep relaxation techniques
Progressive relaxation training- tensing and relaxing various muscle groups. Whilst focusing on the contrast between the initial tension and the subsequent feelings of relaxation of softening- allows them to discover what state their muscles should be in and after repeated practice the individual can recreate the relaxed sensation in situations they feel stressed in.
Step two- client and therapist create an anxiety hierarchy of the feared stimulus
Step three-progresses through hierarchy and uses relaxation technique. Idea is to work their way up the hierarchy until the phobia is completely removed
Evaluation of systematic de-sensitisation
+Gilroy- compared 42 spider phobic patients treated with three, 45 minute sessions of SD with a control group treated with relaxation alone.
3 months and 33 months after treatment SD group showed less fearful responses than the relaxation group. Simple phobias have relatively quick and long lasting therapy.
-SD focuses on learned associations / ignores any deeper underlying psychological or emotional issues. WOLPE case of a woman with phobia of insects - husband was nicknamed after an insect. Recommended a marriage counsellor.
What is flooding?
- extreme exposure to the phobic situation
- sessions take up to 3 hours to try and extinguish phobic response
- conditioned stimulus no longer leads to conditioned response but relaxation instead
- can be used with virtual reality
Evaluate flooding
+can be highly effective and quick treatment for phobias. KAPLIN found 65% of patients with a specific phobia given a single session of flooding showed no symptoms 4 years later
-flooding deliberately creates high levels of anxiety so is a traumatic experience for phobic patients -ethical issues concerning acceptable levels of suffering
What is the ABC model?
A- Activating event ~something happens e.g teacher says work is shit
B-belief ~you have a belief about this event e.g ur a failure
C-consequence ~emotional response to this belief e.g feeling that ur worthless
irrational belief not event that causes consequence
Becks cognitive theory diagram
Negative views
about the world
Negative views Negative views
about the future about oneself
Outline becks cognitive triad
Depression stems from unrealistic, distorted, negative or irrational thoughts about oneself, others or the environment, and from difficulties in controlling thought processes.
May develop negative view of world during childhood- negative schemes lead to cognitive biases in thinking.
Evaluate the cognitive approach to explaining depression.
+there is evidence that depression is associated with negative thinking. GRAZILOI AND TERRY assessed 65 pregnant women for cognitive vulnerability and depression before and after giving birth. Women judged high in cognitive vulnerability were more likely to suffer post-natal depression
+BATES ET AL found that depressed participants who were given negative automatic thought statements became more and more depressed, supporting the view that negative thinking leads to depression
-it ignores biological factors that might be involved in depression. There is strong evidence that biological factors play a very important role in depression. WENDER found that adopted children who develop depression are more likely to have a depressive biological parent. A better explanation might be the diathesis stress model which suggests some peopl inherit a vulnerability to disorders such as depression.
What is logical disputing?
Getting the client to realise that their self-defeating beliefs are not logical. E.g does this thinking make sense?
What is empirical disputing?
Getting the client to realise that their self- defeating beliefs are not realistic e.g where is the proof that this belief is accurate?
What is pragmatic disputing?
Getting the client to realise that their self-defeating beliefs are not useful e.g how is this belief likely to help me?
Evaluate CBT
+a lot of research has shown that CBT is very effective therapy. For instance SMITH AND GLASS did a meta-analysis of therapies and found that CBT had the second highest success rate out of 10 different therapies (second to SD)
+CBT attempts to deal with the cause of depression, not just the symptoms of it. Therefore it offers a long term solution for dealing with mental distress that other therapies, such as drug therapy may not offer.
-CBT is not appropriate for all clients, as they need to have the ability to rationalise and talk about their thoughts and feelings. For those suffering from severe depression it might be very difficult to complete CBT without combining it with medication.
-there is a risk that too much emphasis is placed on thought processes and not enough on the circumstances in which a patient is living, e.g poverty, poor housing etc
-CBT may take a relatively long time to complete. Ellis claimed that clients would need on average 27 sessions to complete the treatment
What’s within the biological approach for OCD?
Genetic explanations Evaluation of this Neural explanations Evaluation of this Drug therapy Evaluation of this
outline the genetic explanation for OCD
Suggests our genetic code is not only responsible for physiological characteristics but also behavioural characteristics
OCD seems to be polygenic-caused by several genes-involved in regulating the development of the serotonin system
SERT GENE appears to be mutated in individuals with OCD. The mutation causes an increase in transporter proteins at a neuron’s membrane. This leads to an increase in the reuptake of serotonin into the neuron which decreases the level of serotonin in the synapse.
COMT GENE is a gene that regulates the function of dopamine. It appears that this gene is also mutated in individuals with OCD. However, this mutation causes the opposite effect as the SERT mutation discussed above. The mutated variation of the COMT gene found in OCD individuals causes a decrease in the COMT activity and therefore a higher level of dopamine.
Evaluate the genetic explanation for OCD
-research provides strong evidence of a genetic component for OCD, but there are no studies that show 100% concordance in MZ twins, suggesting other factors must be involved.
Consistent with the diathesis model which bring n + n together -suggesting that genetic factors predispose an individual to developing OCD, but environmental factors are needed to trigger the disorder
- it is difficult to separate the effects of nature and nurture. MZ twins may be treated more similarly than DZ twins, which may partly account for NESTADTS findings
- genetic research is a relatively new area and it is still not known exactly which genes or combination of genes is relevant.
PAULS ET AL reported up to 10% of first-degree relatives of those with OCD were more likely to develop the disorder compared with approximately 2% prevalence in the general population.-does not control effects of the environment on the development of OCD
NESTADT ET AL reviewed twin studies and found 68% of identical twins showed concordance for OCD compared to 31% in non-identical twins
Outline the neural explanation for OCD
It is believed that OCD may be caused by low levels of neurotransmitter serotonin.
Based on findings that OCD can be relieved by using anti-depressant drugs, especially those which increase levels of serotonin in the brain
Another idea is that OCD is caused by a disruption of serotonin levels which has a knock on effect on regulating the levels of other neurotransmitters -GABA, glutamate, dopamine.
Various areas of the brain have been implicated in OCD. The ORBITOFRONTAL CORTEX sends signals to the THALAMUS about worrying thing such as a potential germ hazard. These are normally suppressed by the CAUDATE NUCLEUS. When the CAUDATE NUCLEUS is damaged it fails to suppress minor worry signals and the THALAMUS is alerted. This sends signals back to the ORBITOFRONTAL CORTEX, acting as a worry circuit.
Evaluate the neural explanation for OCD
+ZOHAR ET AL found that drugs which increase serotonin have been beneficial for up to 60% of patients with OCD. This supports the idea that low levels of serotonin may be associated with OCD. Most studies have found only 50% improvement of OCD symptoms when using meds- other factors are involved
-THE AETIOLOGY FALLACY-not known if the problems with neurotransmitters are a cause or a consequence of OCD.
paras cure headaches- headache isn’t caused by lack of paras
-relationship between OCD and parts of the brain not straightforward. Neuroimaging studies have not identified BASAL GANGLIA IMPAIRMENTS in all OCD sufferers and some people with BASAL GANGLIA IMPAIRMENTS show no sign of OCD
What is involved in the “worry circuit”?
ORBITOFRONTAL CORTEX, CAUDATE NUCLEI AND THALAMUS
Outline biological therapies of OCD: drug therapy
Low levels of serotonin in the “worry circuit” offers an explanation for OCD- increasing levels of serotonin may therefore normalise this circuit and therefore antidepressants may be effective in reducing OCD symptoms
What is the standard treatment used for OCD
SSRI’s eg fluoxetine
These block the re uptake or re absorption of serotonin in the brain. This enables serotonin to remain active at the synapse where it continues to stimulate the post-synaptic neuron, reducing the symptoms of anxiety
-if not effective after 3/4 months - dosage may be increased+ may be used as well as CBT
Tricyclics- block the transport mechanism that reabsorbs serotonin and noradrenaline into the presynaptic cell after it has fired. Has more side effects than SSRI’s.
SNRI’s are also used if patients don’t respond to SSRI’s - they increase levels of noradrenaline and serotonin.
Evaluation of drug therapy for OCD
There is considerable evidence for the effectiveness of SSRI’s for the treatment of OCD .
SOOMRO reviewed 17 studies of the use of SSRI’s with OCD and found them to be more effective than placebos in reducing the symptoms of OCD as measured with Y-BOCS up to 3 months after treatment i.e. In the short term.
However, it has been suggested that 30-50% of clients with OCD derive no benefit from them, so they are not effective for a large minority.
Furthermore, relapse rates are thought to be as high as 90%. - drugs don’t provide a permanent cure
psychological therapies are more effective as they provide the client with active strategies for dealing with the disorder
The implications of psychological research for the economy
Depression and OCD can all impact negatively on an individual’s ability to function adequately, including working. Finding effective treatments for such disorders would reduce the number of days people have off work sick, so improving productivity.
