Psychology

BEHAVIOURAL

• Panic -(crying, screaming or running away from phobic stimulus)
• Avoidance - Avoiding coming into contact with phobic stimulus

EMOTIONAL

• Anxiety and Fear ( Fear leads to anxiety)
• Responses are unreasonale (e.g a strong emotional response to a tiny spider)

COGNITIVE

• Selective attention to the phobic stimulus

The phobic finds it hard to look awat from the phobic stimulus 

• Irrational beliefs

BEHAVIOURAL

• Compulsions

Actions that are carried out repeatedly (to reduce anxiety)

• Avoidance (OCD is managed by avoiding situations that trigger anxiety

EMOTIONAL

• Anxiety and Distress (obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming
• Guilt and Disgust 

COGNITIVE

• Obsessive thoughts ( about 90% of OCD sufferers have obsessive thoughts )
• Insight into excessive anxiety

(Awareness that thoughts and behaviour are irrational ('over-aware' of their obsession)

BEHAVIOURAL

• Low activity levels ( reduced energy levels)
• Disruption to sleep and eating behaviour (reduced sleep or need for sleep)

EMOTIONAL

• Lowered mood (daily feeling of lethargic or sadness)
• Anger (aggression or self-harming)

COGNITIVE

• Poor concentration 
• Absolutist thinking

ABNORMALITY IS BASED ON SOCIAL CONTEXT

• When a person behaves in a way that is different from how thet are expected to behave they may be defined as abnormal

• Concerns behaviour that is different from the accepted standards of behaviour in a community or society

DEVIATION FROM SOCIAL NORMS IS NOT A SOLE EXPLANATION OF ABNORMALITY

A LIMITATION IS THAT SOCIAL NORMS ARE CULTURALLY RELATIVE

• A person from one cultural group may label someone from another group as abnormal using their standards rather thsn the persons standards
  

A FURTHER LIMITATION IS THAT THE DEFINITION COULD LEAD TO HUMAN RIGHT ABUSES

• Such classifications appear ridiculous but some psychologists argue that some modern abnormal classifications are abuses of people right to be different
  

INABILITY TO COPE WITH EVERYDAY LIVING

• Occurs when someone is unable to cope with ordinary demands of day to day living

WHEN SOMEONE IS NOT COPING

• They no longer conform to interpersonal rules (e.g maintaining personal space)
• The experience personal distress
• They behave in a way that is irrational or dangerous

FAILURE TO FUNCTION ADEQUATELY RECOGNISES THE PATIENTS PERSPECTIVE

• Difficult to assess distress
• Although captures the experience of many people who need help and is useful for assessing abnormality

FURTHER LIMITATION IS THAT THIS IS A SUBJECTIVE JUDGEMENT 

• Some might feel distresses (or say) but may not be judged as not suffering 

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

IDEAL MENTAL HEALTH CRITERIA

• We have no symtoms or distress
• we are rational and percieve ourselves as accurately 
• we self actualise 
• we can cope with stress
• we have a realistic view of the world 
• we have good self esteem and lack guilt 
• we are independent of other people
• we can successfully work,love and enjoy our leisure

STRENGTH IS THAT DEVIATION FROM IDEAL MENTAL HEALTH IS COMPREHENSIVE

• Covers a broad range of criteria for mental health
• Probably covers most of the reasons someone seeks help from mental health services or be reffered to help

LIMITATION IS THAT THE DEFINITION MAY BE CULTURALLY RELATIVE

• Might be specific to a culture
• Such traits are typical of individualists cultures and are culturally specific

ANOTHER LIMITATION IS AN UNREALISTICALLY HIGH STANDARD FOR MENTAL HEALTH

• Not everyone would fit the ideal mental health criteria (most of us would be abnormal)

CLASSICAL CONDITIONING 

• Learning by association

Occurs when two stimuli are repeatedly paired together, unconditioned (unlearned) stimulus (UCS) and a new 'neutral' stimulus (NS). The neutral stimulus eventually produces the same response that was first produced by the unlearned stimulus alone

OPERANT CONDITIONING

A form of learning in which behaviour is shaped and maintained by its consequences.

Possible consequences of behaviour include;

• Positive  reinforcement
• Negative reinforcement 
• Punishment

Watson and Raynor 

Showed how a fear of rats could be conditioned in 'Little Albert'

• Whenever Albert played with the white rat, a loud noise was made close to his ears.           The noise (UCS) caused a fear response (UCR)
• Rats (NS) did not create fear until the bang and rat had been paired together several times
• Albert showed a fear response (CR) everytime he came in contact with the rat (Now CS)

Albert also showed a fear in response to other white furry objects includings a fur coat and a Santa Claus mask

STRENGTH OF THE TWO PROCESS MODEL IS IT HAS GOOD EXPLANATORY POWER

• Watson and Rayner explanation of phobias
• Important implications for therapy 

A LIMITATION IS THE TWO PROCESS MODEL IS AN INCOMPLETE EXPLANATION OF PHOBIAS

• Problem with the two process model is there is more to acquiring phobias than simple conditioning 

A LIMITATION IS NOT ALL BAD EXPERIENCES LEAD TO PHOBIAS

• Sometimes phobias appear following a bad experience 
• However sometimes peopoe have a bad experience (bitten by a dog) and dont develop a phobia 
• This suggests that conditioning may only develop where vulnerability exists 

TWO PROCESS MODEL DOESNT PROPERLY CONSIDER THE COGNITIVE ASPECTS OF PHOBIAS 

• Behavioural explanations in general are oriented towards explaining behaviour rather than cognition (thinking)

FAULTY INFORMATION PROCESSING 

Aaron Becks suggested that some people are more prone to depression becuase of faulty information processing (thinking in a flawed way)

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

DEPRESSED PEOPLE HAVE A NEGATIVE SELF-SCHEMAS

• A schema is a 'package' of ideas and information developed through experience. 

Use schemas to interpret the world  

There are three elements to the negative triad

• Negative views of the world 
• Negative view of the future 
• Negative view of the self

A - Activating event 

• Albert Ellis suggested that depression arises from irrational thoughts                                         
• According to Ellis depression occurs when we experience negative events 

B -Beliefs

Negative events trigger irrational beliefs;

• Ellis called the belief that we must always succeed 'musterbation'
• 'I can't stand it itis' is the belief that it is a disaster when things do not go smoothly
• 'Utopianism' is the belief that the world must always be fair and just

C-Consequenes

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

A STRENGTH OF BECKS THEORY IS IT HAS GOOD SUPPORTING EVIDENCE

Grazioli and Terry                                                                                                                          

• Assessed 65 pregnant woman for cognitive vulnerability and depression before and after birth
• They found that those woman judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression
• These cognitions, can be seen before depression develops, suggesting that Beck may be right about cognition casuing depression, at least in some cases

A LIMITATION IS THAT BECKS THEORY DOES NOT EXPLAIN ALL ASPECTS OF DEPRESSION

• Depression is a complex disorder
• Some depressed patients are deeply angry and Beck cannot easily explain this extreme emotion
• Becks theory cannot explain all cases of depression and just focuses on one aspect of the disorder

A LIMITATION IS THAT ELLIS'S MODEL IS A PARTIAL EXPLANATION OF DEPRESSION

• There is no doubt that some cases of depression follow activating events
• Psychologists call this reactive depression and see it as a different kind of depression that aires without an obvious cause 
• This means Ellis's model only applies to some kinds of depression

A GENERAL ISSUE IS THAT COGNITIONS MAY NOT CAUSE ALL ASPECTS OF DEPRESSION

• Cognitive explanations are closely tied up with the concept of cognitive primacy, the idea that emotions are influenced by cognitions (thoughts)

BECK PATIENT AND THERAPISTS WORK TOGETHER 

• Work together go clarify the patients problems 
• Identify where there might be negative or irrational thoughts that will benefit from challenge

CHALLENGING NEGATIVE THOUGHTS RELATING TO NEGATIVE TRIAD

Aims to identify negative thoughts about the self, the world and the future

• thoughts must be challenged  by patients taking an active role in their treatment 

THE PATIENT AS SCIENTIST

• Patients are encouraged to test the reality of their irrational beliefs

ELLIS'S RATIONAL EMOTIVE BEHAVIOUR THERAPY

REBT extends the ABC model to an ABCDE model 

• D for dispute (challenge) irrational beliefs
• E for effect

CHALLENGING IRRATIONAL BELIEFS

• Empirical argument - disputing whether there is evidence to support the irrational belief
• logical argument- disputing whether the negative thought actually follows from the facts

BEHAVIOURAL ACTIVATION

The goal of treatment is to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood (exercing, going out for dinner ect)

Researchers have identified specific genes which create a vulnerability for OCD, called candidate genes:

• Serotonin genes (implicated in the transmission of serotonin across synapses)
• Dopamine genes (also implicated in OCD)

OCD IS POLYGENIC 

OCD is not caused by one single gene but several genes are involved                                           Taylor (2013) found evidence that up to 230 different genes may be involved in OCD

LOW LEVELS OF SEROTONIN LOWERS MOOD 

Neurotransmitters are responsible for relaying information from one neuron to another

DECISION-MAKING SYSTEMS IN FRONTAL LOBES IMPAIRED

• Some cases of OCD (hoarding disorder) seem to be associated with with impaired decision making
• Frontal lobe = logical thinking and making decsions 

PARAHIPPOCAMPAL GYRUS DYSFUNTIONAL

Evidence to suggest that an area called the left parahippocampal gyrus associated with processing unpleasant emotions, funtions abnormally in OCD

GOOD SUPPORTING EVIDENCE FOR THE GENETIC EXPLANATION OF OCD

• Nestadt et al (2010) reviewed twin studies
• Found 68% of identical twins shared OCD
• Non identical shared 31%

ONE LIMITATION IS THAT TOO MANY CANDIDATE GENES HAVE BEEN IDENTIFIED

• Twin studies strongly suggest that OCD is largely genetic
• Psychologists have been less successful at pinning down all the genes involved
• Genetic variation only increases the risk of OCD by a fraction
• Consequences is that a genetic explanation is unlikely to ever be very useful becuase it provides little predictive value

ANOTHER LIMITATON IS THAT ENVIRONMENTAL RISK FACTORS ARE ALSO INVOLVED

• Cromer et al (2007) found some patients had a traumatic event in their past, and OCD was more severe 
• Diathesis-stress model 

SUPPORTING EVIDENCE 

• Antidepressants that work purely on the serotonin system are effective in reducing OCD symptoms and this suggests that the serotonin system may be involved in OCD
• OCD symptoms form part of biological conditions such as Parkinsons disease (Nestasdt et al)
• This suggests that the biological processes that cause the symtoms in those conditions may also be responsible for OCD

ONE LIMITATION IS THAT THE SEROTONIN OCD LINK MAY NOT BE UNIQUE TO OCD

• Many people who suffer from OCD become depressed
• Having 2 disorders together is called co-morbidity
• This depression probably involves disruption to the serotonin system as a possible basis for OCD
• It could simply be that the serotonin systems is disrupted in many patients with OCD becuase they are depressed aswell

CHANGING THE LEVELS OF NEUROTRANSMITTERS

Drug therapy for mental disorders aim to increase or decrease levels of neurotransmitters in the brain or to increase/decrease activity

• Low levels of serotonin are associated with OCD

SSRI =Drug (antidepressant)

• SSRIs prevent the reabsorption and breakdown of serotonin in the brain 
• This increases its levels in the synapse and this serotonin continues to stimulate the postsynaptic neuron

TYPICAL DAILY DOSAGE

• 20mg 
• 3-4 months of daily use for SSRIs to impact symtoms 
• Can be increased to 60mg a day (if appropriate)

COMBINING SSRI WITH CBT (Cognitive behaviour therapy)

• The drugs reduce a patients emotional symtoms (depressed or anxious)
• CBT mean patients can engage more effectively 

ALTERNATIVES

• Tricyclics 
• SNRIs

TREATMENT IS EFFECTIVE 

Soomro et al (2009) reviewed 17 studies comparing SSRIs to placebos 

• SSRIs showed a significantly better result 
• Results are better when SSRIs are combined with CBT
• Symptoms reduced by about 70%

DRUGS ARE COST EFFECTIVE AND NON DISRUPTIVE

• Cheap compared to psychological treatments (good value for NHS)

DRUGS HAVE SIDE EFFECTS

• E.g indigestion, blurred vision and lose of sex drive (temporary)
• 1 in 100 become aggressive 

LIMITATION IS THE EVIDENCE FOR DRUG TREATMENT IS UNRELIABLE 

• Although SSRIs are fairly effective, they have some controversy attached
• Some companies may try to suppress evidence that does not support the effectiveness of certain drugs to maximise their economic gain

ONE PROBLEM IS THAT SOME CASES OF OCD FOLLOW TRAUMA

• OCD is widely believed to be biological in origin (standard treatment should be biological)
• OCD can range of other causes (traumatic events)

TREATMENT IS EFFECTIV

Gilroy et al (2003) 

• Followed up 42 patients who had SD for spider phobia 
• Three 45 minute sessions
• 3 and 33 months, SD group were less fearful than a control group (contol group had relaxtion no exposure)

SUITABLE FOR A DIVERSE RANGE OF PATIENTS

ANOTHER STRENGTH IS THAT SD TENDS TO BE ACCEPTABLE TO PATIENTS

• Patients prefer SD to flooding 
• It does not cause the same degree of trauma as flooding 
• Low refusal rates and low attrition rates (number of people dropping out)

A LIMITATION OF FLOODING IS THAT IT IS LESS EFFECTIVE FOR SOME TYPES OF PHOBIAS 

FUTHER LIMITATION IS THAT FLOODING IS TRAUMATIC FOR PAITENTS 

• Unethical, patients are often unwilling to see it through to the end
• Treatment is then not effective and time and money are wasted

STRENGTH IT IS QUICKER THAN SD