Approaches to Psychopathology

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  • Created by: Lauren
  • Created on: 29-03-13 15:10

Biological Approach

  • Genes can influence biochemistry and neuroanatomy, which could mean that mental illness is inherited.
  • Too little serotonin can cause depression, and too much dopamine can cause psychotic behaviour and hallucinations - symptoms of schizophrenia.
  • Supported by the Gottesman & Sheilds study (evaluated on the next card) and the link between the surge of hormones after pregnancy and postnatal depression.
  • Treated by drugs and ECT.
  • ECT is where two electrodes are placed on either both sides of the head or the centre and the non-dominant side. The patient is injected with barbiturate and a nerve-blocking agent. They receive 0.6 amps for half a second and have a short seizure. This is given 3 times a week, 3-15 treatments.
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Evaluation for Biological Approach

  • Gottesman & Sheilds (1982) conducted a correlational study looking at the rates of schizophrenia in twins. There was a 45% concordance rate for monozygotic twins, and 14% for dizygotic twins. This study shows there is a link between genetics and mental illness.
  • This research is useful as it means medication can be used to relieve mental conditions and offers a familiar, 'patient' role in treatment.
  • However, one problem with this evidence is that it is inconclusive and if genetics caused mental illness, monozygotic twins would have a 100% concordance rate.
  • Social factors are ignored even though they may be linked to mental illness - proved by the success of other treatments like cognitive behavioural therapy.
  • Another problem is that it is impossible to tell if biological changes cause or are caused by mental illness e.g. low serotonin may be the effect of depression, not the cause.
  • Mental illness carries a stigma, but the patient is not blamed.
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Evaluation for Biological Treatments

  • WHO (2001) found that relapse rates for schizophrenia were 28% with chloropromazine alone, but 55% with a placebo. Mulrow et all (2000) found 60% success for tricyclic drugs and only 35% for placebos. These studies show a significant effect with drug treatment.
  • While these studies are internally valid and have sound scientific evidence, only 60-70% of depressed people responded to the drug treatment which leaves 30-40% of patients who didn't benefit from the treatment. Other studies had results showing that placebos were just as good as the drugs, e.g. Kirsch et al.
  • Drugs also only cure the symptoms and can cause side effects such as insomnia, anxiety and suicidal thoughts.
  • Comer (2002) found that 60-70% of people improved after ECT.
  • However, Sackheim et all (2001) claimed 84% of patients relapse within 6 months and there are many side effects such as memory impairment and cardiovascular changes.
  • 50% of patients are not fully informed about these side effects, and depressed individuals may be easy to coerce into the treatment, even though sham ETC worked just as well in many studies.
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Psychodynamic Approach

  • The theory that abnormality is caused by unresolved conflicts in the unconscious mind
  • Freud assumed the psyche was made up of the id, ego and superego
  • The id is instinctive, selfish, impulsive and pleasure orientated. It is developed from birth.
  • The superego is moral orientated and causes anxiety and guilt. Formed at the age of 4 or 5.
  • The ego is the conscious, rational part formed at the age of 1 or 2. It balances the needs of the id and superego.
  • Imbalance could cause abnormality.
  • Treated with psychoanalysis, which is made up of free association, dream analysis and projective tests.
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Evaluation for the Psychodynamic Approach

  • The only research evidence for this approach are case studies. This includes the Little Hans study, where Freud said his fear of horses was stemmed from his rivalry with his father. There is also the Anna O study, where her physical illness was caused by having a sick father as a child, and her physical symptoms disappeared after psychoanalysis treatment. 
  • This approach is very influential and part of our culture today, and was the first theory to focus on psychological causes of disorder.
  • The research is very unreliable, as it is difficult to test scientifically and over emphasises unconscious factors. There is also a lack of population validity due to most of Freud's patients being middle-class Viennese women.
  • This approach also relies less on social factors and puts blame on the parents.
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Evaluation for Psychoanalysis

  • Observations have supported the theory, however it is not scientifically backed and a lack of evidence has led people to believe that the theory and treatment is flawed. It is the first approach to establish talking therapy.
  • Bergin (1971) said 80% out of 10,000 patients benefitted, however.
  • It is criticised because present conflicts are overlooked, and the therapy relies on the analyst's interpretation (no inter-rater reliability), which cannot be proved wrong as it is then classed as denial.
  • Eysenck (1986) criticised the therapy, saying it's no better than placebo or spontaneous remission.
  • The therapy is long-lasting and expensive.
  • May cause emotional distress, and Loftus (1995) said that it could cause false memories.
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Cognitive Approach

  • Behaviour is influenced by thoughts - mental disorder may be caused by distorted thinking like irrational thought processes and cognitive deficiencies.
  • Overgeneralisation = making a sweeping conclusion based on a single, trivial event.
  • Magnification and minimisation = magnifying failure and minimising success.
  • Musterbation = believing you must be able to do something or else.
  • The A-B-C model says that an activating event causes a belief which leads to a consequence.
  • It is treated by challenging irrational beliefs, and REBT uses logical, empirical and pragmatic disputing.
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Evaluation for the Cognitive Approach

  • Thase et al (2007) compared the effects of cognitive therapy to effects of drugs and showed that they are just as effective, and cognitive therapy was better tolerated. This supports the theory that depression is caused by 'faulty thinking'. This approach offers help for people with eating disorders or depression, as it considers the role of thoughts and beliefs. Smith & Glass (1977) combined results from many studies to find the effectiveness of cognitive therapy.
  • One problem with this is that faulty thinking may be the consequence of the mental disorder, not the cause. Another issue is that the theory states the obvious and also that even clinically normal people have irrational thinking. Alloy & Abrahmson (1979) even found that people who were depressed were more realistic thinkers.
  • This approach blames the individual for their mental disorder and may overlook social factors such as bullying.
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Evaluation for Cognitive-Behavioural Therapy

  • Engels et all (1993) concluded that REBT was effective for OCD and social phobia. Cognitive therapies have been proven to be increasingly popular and more effective than drugs alone.
  • Cognitive therapies have successfully treated depression, anxiety and eating disorders, and REBT was useful for clinical and non-clinical groups. It allows a person to take control and make a positive change to their behaviour, and offers a long-term coping strategy.
  • However, it is not suitable for all, as some may reject its direct challenges and some may not put the revised beliefs into action. It also blames the patient and REBT may dismiss religious fears.
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Behavioural Approach

  • Assumes that external factors cause abnormality, and maladaptive/dysfunctional behaviours are learned through classical and operant conditioning.
  • There is also the social learning theory, where behaviour is learned from observing others.
  • This approach is particularly used to explain phobias.
  • The treatment for this approach is systematic desensitisation, where patients are taught how to relax while creating a series of imagined scenes. The patient gradually works their way through this hierarchy as they become less anxious of the imagined scenes, and eventually masters the feared situation.
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Evaluation for the Behavioural Approach

  • Many animal studies were conducted such as pavlov's dogs, where the results were generalised to human behaviour. There is also the Little Albert study, which featured creating a conditioned phobia of white rabbits.
  • There is high internal validity, with lots of testable evidence. The behavioural therapies are also proven to be effective and overcome the issues of stigma and blame.
  • However, conditioning theories do not explain why many people are unable to identify an incident that has led to their phobia, and some psychologists believe that we are biologically prepared to develop fear response to small, quick and potentially dangerous animals to ensure survival.
  • Also, according to the psychodynamic approach, the symptoms are just the tip of the iceberg and the disorder may manifest itself into something else (symptom substitution).
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Evaluation for Systematic Desensitisation

  • Capafons et al (1998) reported lower levels of fear with aerophobics who had undergone systematic desensitisation. There is 75% recovery for phobics and it may be the only treatment possible for certain groups, e.g. people with severe learning difficulties.
  • However, the therapies are dehumanising and are less effective for ancient fears such as the dark, according to Olman et al (1975).
  • It also only deals with the symptoms, and not the cause, and may not provide long-lasting solutions.
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