Abnormality

D: Occurs when an individual has a less common characteristic, for example being more depressed or less intelligent than most of the population.

EVAL:

REAL LIFE APPLICATION > when diagnosing a mental health issue you compare them to the social norms

UNUSUAL CHARACTERISTICS CAN BE POSITIVE > e.g IQ, having v. high is as infrequent as having a low one, but it doesn't need treatment 

NOT EVERYONE BENEFITS FROM A LABEL > people can go about normal lives with no labels, introducing a label could have a negative effect on them 

D: Concerns behaviour that is different from the accepted standards of behaviour in a community or society.

EVAL:

NOT A SOLE EXPLANATION > although has real life application, would need to be used in conjunction with other factors to determine abnormality

CULTURAL REALISM > entirely dependant, culture to culture and generationally, e.g hearing voices = abnormal in UK but ion other cultures this is desirable

LEAD TO HUMAN RIGHTS ABUSE > historical examples, e.g gay people were treated horribly because they were a minority, why should we label people as abnormal just to label people

SOCIAL VS. STATISTICAL NORMS> includes desirability, genius = infrequent but desirable, social norms takes into account if the trait is positive or negative. 

D: Occurs when someone is unable to cope with ordinary demands of day-to-day living, e.g hygiene and nutrition.

Rosenhan + Seligman (1989) - somone if failing to function when if: 

1. no longer conforms to standard interpersonal rules e.g eye contact 2. severe personal distress 3. irrational behaviour/ becoming a danger to themselves

EVAL:

PATIENT'S PERSPECIVE > experience of the patient is important

IS IT JUST DEVIATION FROM SOCIAL NORMS? > we see people who choose to live in strange ways e.g not having a job, if these are choices then aren't we restricting freedom by labelling them as failures??

SUBJECTIVE  > everyone's definition is different. element of opinion, although the Global Assessment of Functioning Scale (GAF Scale) can help to reduce this

D: Occurs when someone does not meet a set of criteria for good mental health

Following criteria set by Marie Jahoda (1958): 

1. No symptoms of distress 2. self actualise 3. rational 4. can cope with stress 5. realistic view of the world 6. good self esteem + lack of guilt 7. independant of others 8. successfully work, love and enjoy leisure time 

EVAL:

COMPREHENSIVE DEFINITION > very clear range of criteria, covering most mental health issues so a good tool for diagnosing

CULTURAL REALISM > culture bound (western societies), emphasis on self-actualisation is not emphasised in other cultures

UNREALISTIC > can anyone meet all of the criteria?? positive - everyone can benefit from treatment like counselling to better themselves, negative - can't use it to diagnose as a healthy and unhealthy person would both be deviant from it

BEHAVIOURAL CHARACTERISTICS: Panic > panic in presence of phobic stimulus, crying, screaming, running away (children may freeze or cling to an adult)  Avoidance > people with phobias tend to try and avoid their feared stimulus by avoidance whereby they will specifically avoid it to avoid their reaction to it Endurance > where a person is exposed to phobic stimulus for extended period of time and they continue to exert anxious response e.g fear of flying 

EMOTIONAL CHARACTERISTICS: Anxiety > emotional response of anxiety and fear in presence of stimulus, prevents sufferer from relaxing and can last a long time Unreasonable responses > disproportionate response to stimulus e.g someone afraid of spiders would freak out over a tiny, harmless spider, but everyone would freak out over a lion (disproportionate response - proportionate response)

COGNITIVE CHARACTERISTICS: Selective attention > only pay attention to the feared stimulus when in presence of it, biological response as they see it as a threat and more attention is higher chance of survival Irrational beliefs > have irrational beliefs about stimulus which compound their fear further. e.g an arachnophobic may think that spiders could eat humans, which obviously they cannot  Cognitive distortions > distorted perception of the phobic stimulus e.g someone with a phobia of cats would see them as ugly and disgusting 

Proposed by Hobart Mowrer (1960)

D: The perception of phobias as acquired through classical conditioning and social learning, with their maintenance upheld through operant conditioning

CLASSICAL CONDITIONING:

Watson and Rayner (1920) - created fear of rats into 'Little Albert' through classical conditioning, combining presence of rat with loud banging noise, fear translated onto the boy. Fear was then generalised to other objects e.g non- white rabbits

OPERANT CONDITIONING:

behaviour is reinforced or punished making it more or less likely to occur, positive and negative reinforcement (removal of unpleasant situation) - like avoiding phobic responses, makes avoidance more likely meaning sufferer does not realise harmlessness of stimulus 

GOOD EXPLANATORY POWER > cause = treatment explains how a phobia can be maintained over time, useful for therapies as explains how patients need to be exposed to stimulus for treatment 

AVOIDANCE BEHAVIOUR > motivated by positive feelings (not the absence of a negative response to their stimulus) of safety, person sticks with safety factor (e.g. agoraphobe may feel less anxiety going outside with someone)

INCOMPLETE > disregards biological evolutionary factors e.g. Seligman (1971) biological preparedness (an innate predisposition) where we have phobias associated with innate knowledge of danger (dark, snakes)

PHOBIAS MAY NOT FOLLOW TRAUMA > some people develop phobias having not even encountered their feared stimulus

DOESN'T EXPLAIN COGNITIVE ASPECTS > irrational beliefs, selective attention and cognitive distortions 

D: A treatment for phobias in which the person is taught to relax and then is gradually exposed to the feared stimulus 

A process of counterconditioning whereby a different response is associated with the feared stimulus, if the patient can learn to relax in the presence of their feared stimulus then they will be cured. 

Steps:

1. Anxiety hierarchy

2. Relaxation techniques

3. Exposure 

EFFECTIVE> Gilroy et al. (2003) followed 42 patients being treated with SD for arachnophobia, measured against a control group and at both 3 and 33 months, SD group was less fearful than control. Shows that it works and that it holds up over time. 

SUITABLE FOR A DIVERSE RANGE OF PATIENTS > flooding and some cognitive therapies not suitable for some patients e.g those who have learning difficulties (cannot engage with the treatment) most appropriate therapy is therefore SD

PATIENTS PREFER IT > pleasant element in SD for patients is the relaxation element and the fact that it does not cause as much trauma. Reflected by the low refusal rates and similarly the low drop out rates, most patients carry out the treatment. 

D: A treatment for phobias in which clients are exposed repeatedly and intensively to a feared object and made to see that it is actually harmless and to reduce their anxiety towards it

- No gradual build up, all at once

- has to endure it for an extended period of time e.g three hours, makes patient realise it is harmless, but also...

- patient wears themselves out by carrying out their fearful response, in the absence of this reaction, they relax

- occurs through the process of EXTINCTION whereby:

the conditioned stimulus is encountered without the presence of the unconditioned stimulus, resulting in the extinction of the conditioned response

- ethicality is very important, patients have to give fully informed consent as it is a traumatic procedure, they need to be mentally prepared beforehand.

COST EFFECTIVE > in comparison to other treatments such as SD, or cognitive therapies, flooding only needs one long session, not lots of short ones. Overall it is cheaper for the same result. Ougrin (2011) found it is quicker than alternatives meaning that patients are also free of symptoms much faster. 

LESS EFFECTIVE FOR SOME PHOBIAS > highly effective for simple phobias, but for social phobias and agoraphobia which contain more cognitive aspects (irrational beliefs) may be more effective to have cognitive therapy in order to cure these.

TRAUMATIC TREATMENT > not unethical due to the consent that is necessary for patients to give, patients are often unwilling to se it through, high drop out rates meaning that they have gone through the stress for nothing and have to start from the beginning again.

SYSTEMATIC SUBSTITUTION  > occurs in both SD and Flooding, in which one fear is replaced with another, thus putting the patient back at square one. 

BEHAVIORUAL CHARACTERISTICS: Activity levels > reduced levels of energy making them lethargic, as a result they tend to withdraw form social activities, school and work, sometimes sufferers cannot get out of bed Disruption to sleep and eating behaviour > reduced sleep (insomnia) or increased sleep (hypersomnia) , weight gain/loss, usual behaviours are disrupted by depression Aggression and self harm > sufferers are often irritable, and physically aggressive to others (quoting job/falling out with friends) or themselves (self harm and sometimes suicide attempts) 

EMOTIONAL CHARACTERISTICS OF DEPRESSION: Lowered mood > main feeling associated with depression, although not just sadness, feelings of worthlessness and emptiness  Anger > alongside sadness, episodes of anger are also common, can lead to aggressive/ self harming behaviour Lowered self-esteem > like and value themselves much less than usual, self-loathing is also common, they feel like they hate themselves 

COGNITIVE CHARACTERISTICS OF DEPRESSION: Poor concentration > sufferers cannot stick to a task like they usually would, find it hard to make decisions. This can interfere with work/schoolAttending too and dwelling on the negative > more pessimistic, not optimistic. Meaning they tend to recall unhappy events, not happy ones compounding their negative feelings further Absolutist thinking > situations are all-good or all-bad, not in-between, black and white. 

Beck 1967 - Certain cognitive style is a pre-existing condition that makes people vulnerable to depression

Three parts to the cognitive venerability

FAULTY INFO. PROCESSING:

suffer tends to dwell on the negative aspects of a situation + blow things out of proportion

NEGATIVE SELF SCHEMAS:

they interpret information around them with a negative tint, cannot see the positives

NEGAVTIVE TRIAD:

1. negative view of the world (no hope)

2. negative views about oneself (reduces self esteem)

3. negative views about the future (no hope) 

GOOD SUPPORTING EVIDENCE  > to support the link between faulty cognitions and depression. Grazioli and Terry (2000) assessed 65 pregnant women for signs of depression before and after birth. Those they assessed as likely to have it were most likely to experience post- natal depression. Clark and Beck (1999) concluded that Beck was right about faulty cognitions causing depression in some cases

PRACTICAL APPLICATION IN CBT > forms basis of a treatment for depression. Negative triad is easily identifiable and makes treatment much more effective

DOESN'T EXPLAIN ALL ASPECTS OF DEPRESSION > some patients are deeply angry, not explained by Beck, hallucinations + Cotard syndrome (believing they are zombies) are also not explained by Beck

COGNITIVE PRIMACY > emotions are influenced by cognitions, sometimes the case although sometimes emotions are not as a result of cognitions, meaning there must be some other force at work which is not explained by Beck 

Ellis (1962) - Irrational beliefs cause anxiety and depression (poor mental health) because good mental health's a result of rational thinking

A: Activating Event

thoughts triggered by external events, these trigger irrational beliefs e.g failing a driving test

B: Beliefs

irrational beliefs surrounding the event e.g I am the worst driver in the world

C: Consequences

results of the beliefs, e.g I am never driving again

These need to be challenged in order to prevent the beliefs and consequently the consequences form occurring 

A PARTIAL EXPLANATION > reactive depression caused by trigger events, although not all depression follows a traumatic event. His explanation only applies to some form of depression 

PRACTICAL APPLICATION IN CBT > it has led to successful explanation like Beck. By challenging irrational beliefs, depression can be reduced (supported by Lipsky et al. 1980). Again, supports idea that irrational beliefs had some role in causing depression

DOESN'T EXPLAIN ALL ASPECTS OF DEPRESSION > same limitation as Beck, no explanation of anger, hallucinations of delusions

ATTACHMENT AND DEPRESSION > infants that have insecure attachments to parents are more vulnerable to depression, incomplete explanation of depression by both Beck and Ellis 

BECK: Idea behind therapy = to identify and therefore challenge (using the negative triad) 

Therapists attempt to make patient test out the reality f their negative thoughts e.g making them do HW which disproves their thoughts (Patient as scientist)

Once disproven aim is to make patient realise that their thoughts are false, therefore relieving their depression

REBT: extends the ABC model - ABCDE model 

D - dispute: patient and therapist can get into vigorous arguments about the reality of the patient's claims, two kinds of argument; LOGICAL (disputing if their claim follows a logical train from the facts) and EMPIRICAL (disputing presence of evidence for their claim

E - effect: by changing the belief, link is broken between thoughts and depression

BEHAVIOURAL CHARACTERISTICS: Compulsions > REPETITIVE, sufferers feel compelled to repeat certain behaviours e.g hand washing. REDUCE ANXIETY, vast majority of sufferers (90%) repeat these behaviours in order to reduce anxiety e.g hand washing is carried out in response to fear of germs Avoidance > sufferers attempt to avoid situations that could trigger OCD e.g compulsive washers would avoid germs

EMOTIONAL CHARACTERISTICS: Extreme anxiety/distress > Obsessive thoughts are unpleasant and frightening Depression > low moods with temporary relief from compulsions Guilt and disgust > feels bad for themselves or are angry at their inability to do things, guilt over minor moral misdemeanours 

COGNITIVE CHARACTERISTICS: Obsessions > reoccurring and unpleasant (cause anxiety which leads to compulsions) Coping strategies > developed by sufferers to deal with stress to achieve relief  Insight into excessive anxiety > recognition that OCD is irrational by sufferer, catastrophic thoughts of what could happen in anxiety was justified. Hypervigillance, potential hazards; constant alertness

D: The perception that OCD is transmitted through inherited factors. Research that supports this comes from twin and family studies. DNA profiling has helped to compare genetic material from OCD sufferers and non-sufferers.

Lewis 1936 - observed that 37% of patients had parents with OCD and 21% had siblings with it, suggests that a venerability is passed down through families, but it is triggered by stress (diathesis-stress model)

CANDIDATE GENES: these genes create venerability for OCD, 5HT1-D beta implicated in the efficiency of serotonin across the synapse.

POLYGENIC: caused by a combination of lots of genes, Taylor 2013 -230 involved in causing OCD

these could be involved with dopamine, serotonin and neurotransmitters that regulate mood

DIFFERENT TYPES OF OCD: aetiologically heterogeneous (one group of genes causes OCD in one person, a different group could cause it in a different person). Different types of OCD have different genetic origin (hand washing and hoarding)

GOOD SUPPORTING EVIDENCE > twin studies used, Nestadt et al. (2010) found 68% of identical twins shared OCD, only 31% of non-identical twins, strongly suggesting that genetics plays a part in OCD

TOO MANY CANDIDATE GENES > difficult to pin down specific genes, each gene only increases venerability to OCD by a fraction. Not very likely to be helpful because little practical application

ENVIRONMENTAL RISK FACTORS > diathesis - stress model, not just genetics that causes OCD. Cromer et al. (2007) over half OCD patients in sample had experienced a traumatic event in their past, more severe the trauma, more severe the OCD. Not entirely genetic in origin

TWIN STUDIES = FLAWED > assumption that identical twins are only more similar in genetic terms, overlook the fact that they could have more similar environments too e.g could be two girls as identical twins (not.a boy and a girl) 

D: The perception that OCD is the result of abnormally functioning brain mechanisms and individual neurons. 

Role of serotonin > neurotransmitter which transfers information from one neutron to another

- serotonin = a mood regulator

- low levels of it means not all mood related information is transferred correctly (can also affect other mental processes), some OCD can be explained by a reduced of serotonin function

Decision-making systems > some OCD esp. hoarding disorder, associated with impaired decision making

- abnormal functioning in: frontal lobes (logical thinking + decision making) + parahippocampal gyrus (processing unpleasant emotions)

SUPPORTING EVIDENCE  > antidepressants which works purely on increasing serotonin in system, work on improving symptoms of OCD. Also, OCD forms basis of other biological conditions e.g Parkinson's disease (Nestadt et al. 2010), suggests OCD may also be biological in origin

WHICH MECHANISMS ARE INVOLVED?  > studies of decision making systems show that they function abnormally in OCD (Cavedini et al. 2002), although other research shows that they are not always involved in the development of OCD, therefore no concrete basis for neural explanations

CAUSE AND EFFECT > do abnormal functions cause OCD, or are these functions as a result of the condition? No way of knowing which way round

CO-MORBIDITY WITH DEPRESSION > many OCD sufferers also have depression (co-morbidity), depression caused by disruption to serotonin system, so has OCD got anything to do with serotonin or is it just depression? 

- serotonin released by presynaptic neuron 

- travels across the synapse

- it chemically conveys signal from presynaptic neuron to postsynaptic neuron

- reabsorbed by presynaptic neuron

- broken down, then reused 

selective serotonin reuptake inhibitors - aim to increase levels of the neurotransmitter serotonin in the brain

- prevent reabsorption of serotonin, therefore increase levels of serotonin in system

typical daily dose = 20mg of Fluoxetine (can be increased if it is not effective up to 60 mg a day)

takes 3/4 months to have a notable effect on serotonin system 

SSRIs often used alongside therapy to treat OCD

- drugs reduce patients emotional symptoms

- meaning that they can concentrate and engage more with CBT

the combination of the two varies from person to person, some people prefer CBT alone whilst others benefit more from a combination of different drugs 

Tricyclics > (old antidepressant)

- same effect on serotonin system

- more severe side effects, so it is usually as last resort for patients 

example: Clomipramine

SNRIs > (newer treatment) serotonin-noradrenaline reuptake inhibitor

- increase levels of serotonin

-also increase noradrenaline levels

- a second line defence for those who do not respond to SSRIs

EFFECTIVE ON SYMPTOMS > Soomro et al. 2009 reviewed studies comparing SSRIs to placebos, all studies showed better results with drugs, with effectiveness at greatest when drugs are combined with CBT. SSRIs help 70% of OCD sufferers 

COST-EFFECTIVE AND NON-DISRUPTIVE > cheaper than psychological treatments, better for the NHS. Patients do not have to engage with difficult CBT, can just take a pill

SIDE-EFFECTS > 30% do not benefit from SSRIs, side effects include: indigestion, loss of sex drive, meaning they have suffered for nothing. For those using Clomipramine, 1/10 patients have more serious side effects: erection problems, weight gain, tremors, 1/100 get low blood pressure + become aggressive, people will stop taking them, then there is no bnefit to the drugs at all

UNRELIABLE EVIDENCE > drug companies sponsor the research into their drugs so the research is biased (Goldacre 2013), is there any concrete evidence for their effectiveness??

OCD FOLLOWING TRAUMA > OCD believed to be biological, so biological treatment makes sense, although when OCD is caused by trauma will drugs have any positive effect on the patient?