Psychopathology

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  • Created on: 24-04-18 18:56
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  • Psychopathology
    • Definitions Of Abnormality
      • Deviation From Social Norms (DSN)
        • Every society has norms. According to the DSN, any behaviour which goes against the unwritten rules and norms of society are abnormal.
        • Strength - Supports the general idea of abnormality: DSN has face validity as it supports the general view that most people have. This means that it is easier for people to identify abnormality within people they know.
        • Limitation - Culture Bias: Social norms vary between cultures, so the definition changes depending on the culture. For example, in some cultures hearing voices is seen as a gift but in other it would be considered abnormal, which could lead to misdiagnosis.
        • Limitation - Social Norms change overtime: Moral standards vary overtime as social attitudes change. Abnormality is very era dependent, so behaviours may not be considered abnormal in future.
      • Failure to Function Adequately (FFA)
        • Behaviour is abnormal if the individual can't deal with day to day life. If it causes distress they may have an inability to function and participate in relationships.
        • Rosenhan and Seligman suggested that some characteristics include: Irrational behaviour and causing observer discomfort.
        • Strength- Real Life Application: Provides a criteria that helps us identify serious cases of mental abnormality. For example, many people experience extreme sadness but the key difference is that it interferes with school/job and relationships.
        • Limitation- Abnormality isn't always linked to FFA: E.g. Howard Shipman was a respectable who functioned adequately but he was responsible for the deaths of over 200 patients over 23yrs.
      • Statistical Infrequency (SI)
        • Abnormal behaviour is rare. Once behaviour is measured, any behaviour that strays too far away from the mean are abnormal. People who use SI measure specific characteristics and how they are distributed in the general population. This can be done by producing a normal distribution curve and anyone who falls outside the mean are abnormal (5%)
        • Strength- Objective and sometimes appropriate: Once a way of collecting data about a behaviour and a 'cut-off' point is agreed on,, it becomes objective in deciding who is abnormal, which helps doctors produce reliable and accurate diagnosis.
        • Limitation- Focuses on frequency rather than desirability: Doesn't account for the rare beahviours that are desirable such as high IQ. An IQ over 160 would be considered abnormal. Also some abnormal behaviours, like depression, are common, so may not always give accurate diagnosis.
      • Deviation From Ideal Mental Health (DIMH)
        • Jahoda stated normal health includes: Positive Attitude Towards Self, Self-actualisation and Personal Growth, Being Resistant To Stress, Personal Autonomy, Accurate Perception Of Reality and Environmen-tal Mastery
        • Strength - Positive approach to viewing abnormality: DIMH offers an alternative view on mental disorders by following on the positive aspects and what is desirable. It also covers a broad range of issues compared to other definitions.
        • Limitation- Unrealistically high standards for mental health, who can achieve this: Stresses of everyday life means it is unlikely that anyone can achieve all criteria for a long time simultaneously, which contributes to misdiagnosis.
        • Limitation- Culture Bias: Based on Western culture, so concepts like self-actualisation and need for autonomy may be a key goal in an individualist culture but in a collectivist culture, elders may decide the future of young members, limiting how effectively they can diagnose abnormality in a non-western culture.
    • Phobias
      • Charactersistics
        • Beahvioural: Panic, Avoidance, and Endurance
        • Cognitive: Decrease in concentration in the presence of the phobic stimulus, Irrational Beliefs.
        • Emotional: Anxiety, Emotional responses are unreasonable.
      • Types of phobias: Specific (certain object or situation), Social (Fears involving other people) and Agoraphobia (fear of public places)
      • Behavioural Approach to Explaining Phobias
        • The two-process model:     Behavioural approach emphasises the role of learning in the acquisition of behaviour. Focuses on behaviour – what we can see, and it geared towards explaining the avoidance, endurance and panic aspects of phobia.
          • Mowrer (1960) proposed two-process model based on the behavioural approach to phobias. This states that phobias are acquired by classical conditioning and continued because of operant conditioning. 
            • Acquisition by Classical Conditioning (CC): CC involves learning to associate something of which we initially have no fear of (neutral stimulus) with something that already triggers a fear response known as the unconditioned stimulus.
            • Maintenance by Operant Conditioning (OC): Conditioned response acquired by CC tend to decline over-time. However, phobias are often long lasting. Mowrer explains this as the result of OC. Reinforcement increases frequency of behaviour. In the case of negative reinforcement an individual avoids a situation that is unpleasant or threatening for them, in order to end the unpleasant experience. 
        • Strength:   Research Support: Watson and Rayner induced a phobia into a 9-month-old baby called ‘Little Albert.’ At the start he showed no unusual anxiety. When he was shown a white rat, he tried to play with it, however, the experimenters made a loud, frightening sound near his ear each time the rat was presented, which made Albert become scared of the rat without the noise, showing that the rat became associated to the loud noise.
        • Strength: Good explanatory power and implications for therapy: Explains how phobias are maintained over-time which had important implications for therapies as it explains why patients need to be exposed to the feared stimulus. This led to practical applications through treatments like flooding where patients are prevented from avoiding the phobic stimulus, eventually helping them get over their phobia.
        • Limitation: Incomplete explanation of phobias: Bounton (2007) - evolutionary factors have an important role in phobias too. For example, we easily acquire phobias of things that have been a danger to us in the past, such as fears of snakes as it is adaptive to have these. Whereas it is much rarer to have a phobia guns or cars which are more dangerous to us today. Seligman called this biological preparedness – the innate predisposition to acquire such fear
        • Limitation:     Alternative explanation for avoidance behaviour: Behaviourist explanation doesn't account for other credible factors that also lead to phobias such as faulty cognitions. Cognitive approach proposes that phobias may develop due to irrational thinking. Thoughts like these then contribute to feelings of anxiety that leads to a person showing emotional symptoms of phobias. 
      • The Behavioural Approach To Treating Phobias
        • Systematic Desensitisation (SD)
          • Why it Works: It 's impossible to experience 2 opposite emotions (fear + relaxation) at the same time. SD uses CC to replace irrational fears and anxieties associated to phobic stimulus with relaxation.
          • 3 processes involved in SD: 1. Anxiety Hierarchy –events causing a little more anxiety than the previous.   2.Relaxation. 3.Exposure –Patient works through each anxiety evoking event while arranging in the competing relaxation response. Once the patient has mastered one step in the hierarchy they are ready to move onto the next. Patient eventually masters the feared situation that caused them to seek help in the first place. 
        • Flooding
          • How it works: It's a rapid and repeated exposure to a phobic stimulus without a gradual build-up in an anxiety hierarchy. Immediate exposure is a very frightening situation for an extended period. 
          • Why it works: Flooding stops phobic responses quickly as the patient doesn't have the option to avoid the phobic stimulus, so they soon learn it’s harmless (known as extinction). This is when the conditioned stimulus is encountered without the unconditioned stimulus – the conditioned stimulus no longer produces the conditioned response.
        • Strength: Effectiveness of SD: Gilroy et al (2003) followed up 42 patients who were treated for arachnophobia in 3 45 minute SD sessions. A control group was treated by relaxation without exposure. At 3 and 33 months after treatment the SD group were significantly less fearful than the control group.
        • Strength: Appropriateness: Flooding procedures in general require less conscious effort from the patients compared to psychotherapies where patients must play a more active part in their treatment. Ougrin (2011) compared behavioural therapies to cognitive therapies and found that behavioural therapies are significantly quicker. 
        • Limitation:  Flooding treatment is traumatic – Flooding requires patients to give consent to giving up their right to withdraw. As a result, trauma can be excessive and have physical symptoms (such as fainting) due to which patients are unable to see the treatment through to the end. I the treatment is left incomplete, it can be a waste of time and money for some people.
        • Limitation: Symptom Substitution: The psychodynamic model claims behavioural therapies focuses on symptoms and ignores causes of abnormal behaviour. Psychoanalysts claim the real cause of phobias may be traumatic childhood experiences which are repressed by the unconscious mind. They believe behavioural therapies don't deal with these issues, it tries to alleviate anxiety caused by it. Unless underlying issues are addressed, the problem will show itself through different symptoms 
    • Depression
      • Characteristics
        • Behavioural: Change in Activity (reduced amount of energy resulting in  fatigue and high levels of anxiety), Social Impairment (reduced interaction with friends) and Change in Eating and Sleeping habits.
        • Emotional: Depressed Mood, Loss of Interest and Pleasure, and Worthlessness (constant feelings of low self-worth)
        • Cognitive: Reduced Concentration, Negative Beliefs about Self and Suicidal Thoughts
      • Cognitive Approach (CA) To Explaining Depression
        • Beck's Negative Triad (He believed depression is caused by negative thinking, especially of oneself and that negative thinking comes before the development of depression.
          • Negative Cognitive Triad: Depression is composed of 3 components which are known as the cognitive triad. These negative views affect cognitive processing (memory and problem solving). Each feed another
            • The self, where individuals see themselves as helpless, worthless and inadequate. The world, where obstacles and issues perceived within ones’ environment can't be dealt with. The future, where personal worthlessness is seen as blocking any improvement. This forms an unending, intrusive cycle of depressive thoughts that cannot be controlled by the thinker.
          • Negative self-schemas: Beck believes depressed people develop negative schemas about themselves, making them think a negative way. These develop in childhood and adolescence – rejection by parents or friends or loss of a close family member. Such negative events mould the person’s concept of themselves as unwanted or unloved, which filters into adulthood and they have a negative framework to view life (pessimistic). This causes systematic cognitive biases.
          • Cognitive biases: People with negative schemas become prone to making errors in their thinking. They tend to focus selectively on certain aspects of a situation and ignore equally relevant information  (cognitive biases). Over generalisation – a sweeping conclusion on the basis of a single event. 
          • Negative schemas with cognitive biases make up the negative triad.
        • Ellis' ABC Model (He believed that interpretation of negative events is to blame for their distress. He proposed that the key to depression lay in irrational beliefs)
          • A refers to an activating an event (whatever starts things off: a circumstance, event or experience)
          • B is the belief, which is either rational or irrational;
          • C is the consequence, which are basically your reaction to the beliefs (rational=healthy emotion; irrational=unhealthy emotion)
          • The consequence is caused by the belief of an activating event – irrational beliefs lead to unhealthy emotions which lead to depression.
        • Strength: Research Support from Koster et al: Student volunteers were presented with positive, negative and neutral words. They found that depressed participants spent longer attending to negative words than the non-depressed group. This supports the aspect of cognitive biases and those with depression attend to negative aspects of their life rather than positive.
        • Strength: Practical Application: Understanding schemas and cognitive processes arising from these theories have led to the development of treatments which target faulty cognitions such as CBT. Beck reviewed effectiveness of CBT and found it highly effective in treating depression.
        • Limitation: Cause or effect: This theory uses evidence which is often correlational. As a result, it's hard to determine the extent to which distorted cognitive pattern’s cause depression. For example, we cannot say for definite that faulty schemas cause depression or depression causes faulty schemas. 
        • Limitation:A more holistic approach is needed: CA of depression focuses on internal mental thoughts and ignores credible research from other approaches. For example, the CA underplays biological factors  such as low levels of serotonin.
      • CA To Treating Depression
        • Beck's CBT (Cognitive Behavioural Therapy aims to identify/alter negative and irrational beliefs  and expectations and alter dysfunctional behaviours contributing to depression.)
          • CBT was developed by Beck based on his theory of depression. The idea behind the CBT is to identify the autonomic thoughts about the world, self and future.
            • Thought Catching: Identification of faulty beliefs. Individuals are taught to see thelinks between their thoughts and emotions/behaviour. As part of the homework assignment, they should record any emotion-arousing events.
            •    Challenging Beliefs: Thoughts are then challenged through discussion. Therapist may demonstrate negative effects of such beliefs and start dispelling them. As part of their assignment the clients may work as a scientist to conduct reality testing to test the validity of their negative beliefs.
            • Cognitive Restructuring: Challenge thoughts and replace them with constructive and effective thoughts, which leads to positive thoughts, thus reducing the symptoms of depression. 
        • Ellis’ Rational Emotive Behavioural Therapy (REBT) - The central technique of REBT is to identify and dispute irrational thoughts.
          • Empirical Disputing: Target irrational beliefs may not be consistent with evidence i.e. ‘where is the evidence that this thought is true?’
          • Logical Disputing: Target irrational beliefs that do not follow logically from the information available i.e. ‘Does this belief make common sense?’
          • Pragmatic (functional) Disputing: Emphasises usefulness of irrational beliefs i.e. ‘is my irrational belief making things worse or better?’
          • Effective Disputing changes self-defeating beliefs into more rational beliefs and the client can move to more rational interpretations of events. This helps the depressed client feel better and become more self-accepting. 
          • Behavioural Activation: Depressed people don’t enjoy activities they previously did. CBT/REBT identify pleasurable activities and overcome obstacles in doing them. 
            • CBT was developed by Beck based on his theory of depression. The idea behind the CBT is to identify the autonomic thoughts about the world, self and future.
              • Thought Catching: Identification of faulty beliefs. Individuals are taught to see thelinks between their thoughts and emotions/behaviour. As part of the homework assignment, they should record any emotion-arousing events.
              •    Challenging Beliefs: Thoughts are then challenged through discussion. Therapist may demonstrate negative effects of such beliefs and start dispelling them. As part of their assignment the clients may work as a scientist to conduct reality testing to test the validity of their negative beliefs.
              • Cognitive Restructuring: Challenge thoughts and replace them with constructive and effective thoughts, which leads to positive thoughts, thus reducing the symptoms of depression. 
        • Effectiveness
          • Strength:    Support for effectiveness of CBT – CBT is effective in reducing symptoms of moderate and severe depression and preventing relapse. Ellis claimed a 90% success rate of REBT, taking an average of 27 sessions. David et al (2008) compared effectiveness of REBT, CBT and drug therapy – all 3 were comparably effective. At 6 month follow up, it was evident REBT was more effective than the other forms of therapy.
          • Limitation: Competence of Therapist – Kuyken (2009) concluded 15% of variance in the outcome may be attributed to therapist competence. Found therapists who were assessed as most competent had better patient outcome regardless of the complexity of the case.
        • Appropriateness
          • Strength: Factors affecting the choice of treatment – Techniques of CBT are appropriate for use in a wide variety of situations and modes of delivery. Has been used successfully with people of all ages with from mild to severe depression. CBT has  no negative effects, which makes it suitable to a wider variety of people.
          • Limitation:    Responses to CBT: Difficult to predict which clients will respond well to CBT. Simons (1995) found that CBT was not effective for people with very rigid attitudes and people who have high stress levels due to long-term problems in their lives that a brief treatment like CBT cannot resolve.
    • Obsessive Compulsive Disorder (OCD)
      • Characteristics
        • Behavioural: Compulsions are repetitive and Compulsions reduce Anxiety
        • Emotional: Anxiety and Distress and Guilt and Disgust
        • Cognitive: Recurrent and Persistent Thoughts and Insight into Excessive Anxiety (Aware that their obsessions and compulsions are irrational0
        • Obsessions: Persistent thoughts that are intrusive, unwanted and cause anxiety. The individual tries to suppress these thoughts or neutralise them with other thoughts or action.
        • Compulsions: Repetitive behaviours in response to an obsession. These behaviours are designed to reduce anxiety or prevent a dreadful event occurring. They are excessive and can be unrealistic. 
      • The Biological Approach to Explaining OCD
        • Genetic Explanation for OCD
          •  Candidate genes: Specific genes lead to a vulnerability of OCD. 5-HTT gene affects transportation of serotonin causing a lower level of serotonin in the synapses.  Ozaki et al (2003) found a mutation of the 5-HTT gene in a family where 6/7 people had OCD. 
          • Polygenic – OCD might be a polygenic disorder as more than one gene may cause it. Taylor (2013) did a meta-analysis and found evidence of up to 230 different genes involved in OCD.
          • Genetic Explanation focuses on OCD being inherited through genetic transmission.
          • Strengths: Research Support: Nestadt et al found the lifetime incidence of OCD was higher in the relatives of OCD patients (11.7%) compared to relatives of healthy controls (2.7%). A meta-analysis of 14 twin studies found MZ twins were twice as likely to develop OCD if their co-twin had the disorder, than DZ twins (Billet). This shows that if we share genes with someone with OCD, we are more likely to develop it.
          • Limitation: Stress Diathesis Model: Suggests that genes are vulnerable to OCD – to develop OCD something in the environment needs to trigger it (stressor). Cromer et al – over half of OCD patients in a sample also had a traumatic experience in the past – more severe with traumatic experience.
        • Neural Explanations
          • Abnormal levels of Neurotransmitters: Serotonin is believed to prevent repetitive tasks. Lower levels of serotonin is associated with OCD – this also means that there is a loss of the inhibitor that inhibits task repetition. E.G.  anti-depressant drugs that increase serotonin activity have  shown to reduce OCD symptoms (Pigott et al), so we can assume that low levels of serotonin lead to OCD.
          • Abnormal Brain Activity: Orbitofrontal Cortex (OFC) sends worry signal   Caudate Nucleus (Normal) – Suppresses minor signals, lets major ones through. (OCD) – Can't suppress minor signals. Thalamus – Confirms and receives minor signals, which is fed back into OFC, creating a worry circuit (OCD). (Normal) – Attends to worry signal and initiates a reaction.
          • Strength: Research Support: PET scans have shown that OCD patients (taken while their symptoms are active) show high activity in the OFC. Paul et al used neuroimaging and found unusually high activation in the OFC.
          • Limitation: Cause and Effect: Correlation doesn’t mean causation. Brain studies show an association between increased activity in OFC and OCD behaviour but idoesn’t show that they have a casual role in OCD, so there may be other factors that influence OCD. 
      • The Biological Approach to treating OCD: Drug Therapies
        • SSRI’s (Selective Serotonin Reuptake Inhibitors): They increase level of serotonin in synapse which regulates mood and anxiety. Blood reuptake at pre-synaptic leaving more serotonin in synapse. Increase in serotonin influences activity of post-synaptic.
        • Tricyclics (SRI’s – Serotonin Reuptake Inhibitor): They'e less selective in their actions and block reuptake of serotonin and noradrenaline into pre-synaptic nerve, leaving more in the synaptic gap. Tricyclics increase serotonin and noradrenaline activity, which regulates mood/anxiety, increasing amount available to be taken up by other nerves. 
        • Effectiveness
          • Strength:   Research Support: Soomro reviewed 17 SSRI’s and found that they were more effective than placebos in reducing symptoms for 3 months. Decline in symptoms for 70% of patients and 30% used alternative drug treatments or psychological treatment, which was effective. This shows that drugs can help most people with OCD.
          • Limitation:Not a Lasting Cure: Simpson et al – 45% treated with clomipramine (SRI) relapsed within 12 weeks compared to 12% relapse rate for those who had received psychological therapy. 
        • Appropriateness
          • Strength: Preferred Treatment: Doesn’t disrupt OCDlpatient's lives like CBT as it requires little effort. Due to this, patients will prefer drug therapies as they require less conscious effort. From the point of view of health services, it is cheaper than psychological therapies and there are lower attrition rates as patients will stick to the drug therapy.
          • Limitations: Side Effects: Common side effects for SSRI’s include: nausea, insomnia, headache, loss of sex drive, indigestion and blurred vision. For SRI’s side effects include: hallucinations, weight gain and irregular heart-beat. As a result, this should be used as a second line of treatment. Side effects aren’t suitable to everyone and is likely to put people off, which reduces the appropriateness

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