- Created by: AshLia
- Created on: 22-11-17 18:40
Defining abnormality in terms of statistics
The most obvious way to define anything as 'normal' or 'abnormal' is in terms of the number of times it is observed
Behaviour that is rarely seen as abnormal
Any relatively 'unusual', or often seen, behaviour can be thought of as 'normal'. Any behaviour that is different, or rare, is 'abnormal'
E.g - IQ and intellectual disability disorder
IQ is normallly distributed. The average IQ is 100. Most people have an IQ between 85 and 115, only 2% have a score below 70. Those induviduals scoring below 70 are statistically unusual or 'abnormal' and are diagnosed with intellectual disability disorder.
Statistical Infrequency - Evaluation
- All assessment of patients with mental disorders includes some comparison to statistical norms. Intellectual disability disorder demonstrates how statistical infrequency can be used. Statistical infrequency is thus a useful part of clinical assessment.
- If very few people display a behaviour, that makes the behaviour statistically abnormal but doesn't mean the person requires treatment. IQ scores over 130 are just as unusual as those below 70, but not regarded as undesirable and requiring treatment. This is a serious limitation of the concept of statistical infrequencyand it means it should never be used alone to make a diagnosis.
- When someone is living a happy and fulfilled life, there is no benefit to them being labelled as adnormal. Someone with a very low IQ who was not distressed or out of work would not need a diagnosis of intellectual disability. Being labelled as abnormal might have a negative effect on the way others view them and the way they see themselves.
Deviation from Social Norms
Abnormality is based on social context
- When a person behaves in a way that is different from how they are expected to behave they may be defined as abnormal. Societies and social groups make collective judgements about 'correct' behaviours in particular circumstances.
Three stypes of consequences of behaviour
- There are relitively few behaviours that would be considered universally abnormal therefore definitions are related to cultural context. This included historical differences within the same society. For example, homosexuality is viewed as abnormal in some cultures but no others and was considered abnormal in out society in the past.
Example: antisocial personality disorder (APD)
- One important symptom of APD is a failure to conform to 'lawful and culturally normative ethical behaviour'. In other words, a psychopath is abnormal because they deviate from social norms or standards. They gernerally lack empathy.
Deviation from Social Norms - Evaluation
- APD shows there is a place for deviation from social norms in thinking about what is abnormal. However, there are other factors to consider, e.g. distress to other people due to APD. So in practice, deviation from social norms is never the sole reason for defining abnormality
- A person from one cultual group may label someone from another group as abnormal using their standards rather than the person's standards. For example, hearing voices is socially acceptable in some cultures but would be seen as a sign of abnormality in the UK. This creates problems for people from one culture living with another cultural group.
- Too much reliance on deviation from social norms to understand abnormality can lead to a systematic abuse of human rights. Drapetomania and *********** are examples of how diagnosis was used for social control. Such classifications appear ridiculous but some psychologists argue that some modern abnormal ckassifications are abuses of people's right to be different.
Failure to Function Adequately
Inability to cope with everyday living
A person may cross the line between normal and abnormal at the point that they cannot deal with the demands if evergday life - they fail to function adequately. For instance, not being able to hold down a job, maintain relationships or maintain basic standards of nutrition or hygiene.
Rosenhan and Seligman (1989) propsed signs of failure to cope
When someone is not coping:
- They no longer conform to interpersonal rules
- They experience personal distress
- They behave in a way that is irrational or dangerous
Example: intellectual disability disorder
Having a vert low IQ is statistical infrequency but diagnosis wouldn't be made on this basis alone. There would have to be clear signs that the person was not able to cope with the demands of everyday living.
Failure to Function Adequately - Evaluation
- This may not be an entirely satisfactory approach because it is difficult to assess distress. However, the definition acknowledges that the experience of the patient is important. It captures the experience of many people who need help and is useful for assessing abnormality.
- It can be hard to say when someone is really failing to fuction or just deviating from social norms. People who live alternative lifestyles or do extreme sports could be seen as behaving maladaptively. If we treat these behaviours as 'failures to function adequately we may limit freedom.
- Someone has to judge whether a patient is distressed or distressing. Some patients may say they are distressed but may be judged as not suffering. There are methofd for making such judgements as objective as possible, including checklists such as the Global Assessment of Functioning Scale. However, the principle remains someone, e.g. a psychiatrists, has the right to make this judgement.
Deviation from Ideal Mental Health
Changing the emphasis
A different way to look at normality and abnormality is to think about what makes someone 'normal' and psychological healthy. Then identify anyone who deviates from this ideal.
Jahoda listed 8 criteria
Marie Jahoda (1958) suggestsed the following criteria for ideal mental health:
- We have no symptoms or distress
- We are rational and percieve ourselves accurately
- We self-actualise
- We can cope with stress
- We have a realistic view on 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
Deviation from Ideal Mental Health (2)
Inevitable overlap between definitions
Someone's inability to keep a job may be a sign of their failure to cope with the pressures of work. Or as a deviation from the ideal of successfully working.
Deviation from Ideal Mental Health - Evaluation
- The definition covers a broad range of criteria for mental health. It probably covers most of the reasons someone would seek help from mental health services or be referred for help. The sheer ranged of factors discussed in relation to Jahoda's criteria make it a good tool for thinking about mental health.
- Some of the ideas in Jahoda's classification of ideal mental health are specific to Western European and North American cultures. For example, the emphasis on self-actualisation would be considered self-indulgent in much of the world where the focus is on community rather than oneself. Such traits are typical of individualist cultures and are culturally specific.
- Very few people will attain all Jahoda's for mental health. Therefore, this approach would see most of us as abnormal. However, it is probably of no value in thinking about who might benefit from treatment against their will.
- Panic - This may involve a range of behaviours such as crying, screaming or running away from the PS
- Avoidance - Considerable effort to avoid coming into contact with the PS. This can make it hard to go about everyday life, especially if the phobic stimulus is often seen.
- Anxiety & Fear - Fear is the immediate experience when a phobic encounters or thinks about the PS. Fear leads to anxiety.
- Responses are unreasonable - Response is widely disproportionate to the threat posed
- Selective attention to phobic stimulus - The phobic finds it hard to look away from the PS
- Irrational beliefs - Forexample, social phobias may involve beliefs such as 'I must always sound intellegent'
- Compulsions - Actions that are carried out repeatedly. The same behaviour is repeated in a ritualistic way to reduce anxiety.
- Avoidance - The OCD is amaged by avoiding situations that trigger anxiety
- Anxiety & Distress - Obsessive thoughts are unpleasant and frightening, and the anxiety that goes that goes with these can be overwhelming
- Guilt & Disgust - Irrational guilt which is directed towards oneself or something external like dirt
- Obsessive Thoughts - About 90% of OCD sufferers have obsessive thoughts
- Insight into Excessive Anxiety - Awareness that thoughts and behaviour are irrational. In spite of this, sufferers experience catastrophic thoughts and are hypervigilant of their obsession
- Activity - Sufferers of depression have reduced levels of energy making them lethargic
- Diruption of Sleep - Sufferers may experience reduced sleep or an icreased need for sleep
- Poor Concentration - Sufferers may find themselces unable to stick with a task as they usually would or might find making simple decisions difficult
- Absolutist Thinking - 'Black and white thinking', when a situation is unfortunate it is seen as an absolute disaster
- Lowered Mood - More pronounced than the daily experience of feeling lethargid or sad
- Anger - On occasion, such emotions lead to agression or self-harming behaviour
Behavioural Approach - Explaining Phobias
The Two Process Model:
Classical conditioning and operant conditioning: Orval Hobart Mowrer (1960) argued that phobias are learned by classical conditioning and then maintained by operant conditioning, i.e. two processes are involved
Acquisition by classical conditioning: Classical conditioning involves association.
- UCS triggers a fear response (fear is a UCR)
- NS is associated with the UCS
- NS becomes CS producing fear
Behavioural Approach - Explaining Phobias (2)
Little Albert: conditioned fear: Watson and Raynor (1920) showed how a fear of rats could be conditioned in 'Little Albert'
- Whenever Albert played with a white rat, a loud noice was made close to his ear. The noise (UCS) caused a fear responce
- Rat (NS) did not create fear untill the bang and the rat had been paired together several times
- Albert showed a fear response (CR) every time he came into contact with the rat (now a CS)
Generalisation of fear to other stimuli: For example, Little Albert also showed a fear in repsonse to other wgute furry objects uncluding a fur coat and a Santa Cluase mask.
Behavioural Approach - Explaining Phobias (3)
Maintenance by operant conditioning (negative reinforcement): Operant conditioning takes place when out behaviour is reinforced or punished.
Negative Rienforcement - an induvidual produces behaviour that avoids something unpleasent
When a phobic avoids a phobic stimulus they escape the anxiety that would have been experienced
This reduction in fear negatively reinforces the avoidance behaviour and the phobic is maintained
Example of negative reinforcement: If someone has a morbid fear of clowns (coulrophobia) they will avoid circuses and other situations where they may encounter clowns.
The relief felt from avoiding clowns negatively reinforces the phobia and ensures it is maintained rather than cofronted.
Behavioral Approach - Phobias (4) - Evaluate
- It has good explanatory power as the two-process model went beyond Watson and Rayner's simle classical conditioning explanation of phobias. It has important implicatons for therapy. If a patient is prevented from practicing their avoidance behaviour then phobic behaviour declines
- In more complex behaviours like agoraphobia, there is evidence that at least some avoidance behaviour is motivates more by positive feelings of safety. This is a problem for the two-process model, which suggests that avoidance is motivates by anxiety reduction.
- Sometimes phobias do appear following bad experience and it is easy to see how they could be the result of conditioning. However, sometimes people have a bad expirence (such as being bitten by a dog) and don't develop a phobia (DiNardo et al 1988). This suggests that conditioning alone cannot explain phobias.
- The two-process model doen't properly consider the cognitive aspect of phobias as we know that behavioural explinations in general are oriented towards explaining behaviour rather than cognition.
Behavioural Approach - Treating Phobias
Systematic Desensitisation (SD):
Based on classical conditioning, counterconditioning and reciprocal inhibition. The therapy aims to gradually reduce anxiety through counterconditioning:
- Phobia is learned so that phobic stimulus (conditioned stimulus, CS) produces fear (conditioned responce, CR)
- CS is paired with relaxation and this becomes the new CR
Reciprocal inhibition - it is not possible to be afraid and relaxed at the same time, so one emotion prevents the other
Formation of an anxiety hierarchy. Patient and therapost design an anxiety hierarchy - a list of fearful stimuli arranged in order from least to most frightening. An arachnophobic might identify seeing a picture of a small spider as low on their anxiety hierarchy and holding a tarantula the final item
Behavioural Approach - Treating Phobias (2)
Relaxation practised at each levelof the hierarchy. Phobic induvidual is first taught relaxation techniques such as deep breathing and/or meditation.
Patient then works through the anxiety hierarchy. At each level the phobic is exposed to the phobic stimulus in a relaxed state.
This takes place over several sessions starting at the bottom of the hierarchy. Treatment is successful when the person can stay relaxed in situations high on the hierarchy.
Behavioural Approach - Treating Phobias (3)
Immediate exposure to the phobic stimulus. Flooding involves bombarding the phobic patient with the phobic object without a gradual build-up
An arachnophobic recieving flooding treatment may have a large spider crawl over their hand until they can relax fully
Very quick learning through extinction. Without the option of avoidance behaviour, the patientquickly learns that the phobic object is harmless through the exhaustion of their fear response. This is known as extinction.
Ethical safeguards. Flooding is not unethical but it is an unpleasent experience so it is important that patients give informed concent. They must be fully prepared and know what to expect
Behavioural Approach - Phobias (4) - Evaluate
- Gilroy et al (2003) followed up 42 patients who had SD for spider phobia in three 45 minute sessions. At both three and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure. This is a strength because it shows that SD is helpful in reducing the anxiety in spider phobia and that the effects of the treatment are long-lasting
- It is also suitable for a diverse range of patients as the alternatives to SD such as flooding and cognitive therapies are not well suited to some patients. For example, having learning difficulties can make it very ahrd for some patients to understand what is happening during flooding or to enhahe with cognitive therapies which reuqire refelction. For these patients, SD is probably the most appropriate treatment.
Behavioural Approach - Phobias (5) - Evaluate
- Although flooding is highely effective for treating simple phobiasd, it appears to be less so for more complex phobias like social phobias. This may be because social phobias have cognitive aspects, e.g. a sufferer of social phobia doesn't simply experience enxiety but thinks unpleasent thoughts about the social situation. This type of phobia may benefit more from cognitive therpaies because such therapies tackle the irrational thinking.
- Perhaps the most serious issue with the use of flooding is the fact that it is a highly traumatic experience. The prblem is not that flooding is unethical as patients do give informed concent but that patients are often unwilling to see it through to the end. This is a limitation because ultimately it means that the treatment is not effective, and time and money are wasted preparing patients only to have them refuse to start or complete treatment.
Cognitive Approach - Explaining Depression
Beck's cognitive theory of depression:
Aaron Beck (1967) suggested that some people are more prone to depression because of faulty information processing, i.e. thinking in a flawed way.
When depressed people attend to the negative aspects of a situation and ignore positives, they also tend to blow small problems out of proportion and think in 'black and white' terms.
A schema is a 'package' of ideas and information developed through experience. We use schemas to interpret the world, so if a person had a negative self-schema they interpret all information about themselves in a negative way.
There are three elements to the negative triad: negative views of the world, negative views of the future and negative views of the self.
Cognitive Approach - Explaining Depression (2)
Ellis' ABC Model:
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, for example:
- Ellis called the belied that we must always succeed 'musterbation'
C - Consequences
When an activating events triggers irrational beliefs there are emotional and behaviour consequences. For example, if you belief you must always succeed and then you fail something, the consequence is depression.
Cognitive Approach - Explaining Depression (3)
- For example, Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. They found that those women judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression. These cognitions can bee seen before depression developes, suggesting that Beck may be rights about cognition causing drepression... at least in some cases.
- There is no doubt that some cases of depression follow activating events. Psychologists call this reactive deression and see it as different from the kind of depression that arises without an ovious cause. This means that Ellis' explanation only applies to some kinds of depression.
Cognitive Approach - Treating Depression
Cognitive Bheaviour Therapy (CBT)
Patient and therapist:
- Work together to clarify the patient's prblems
- Identify where there might be negative or iraational thouhgts that will benefit from challenge
The aim is to identify negative thoughts about the self, the world and the future - the negative triad. These thoughts must be challenged by the patient taking an active role in their treatment.
Patients are encourages to test the reality of their irrational beliefs. They might be set homework! This is referred to as the 'patient as scientist'. In future sessions if patients say that no-one is nice to them or there is no point going on, the therpaist can produce this evidence to prove the patient's beliefs incorrect.
Cognitive Approach - Treating Depression (2)
Rational Emotive Behaviour Theapy (REBT)
REBT extends the ABC model to be an ABCDE model:
- D for dispute irrational beliefs
- E for effect
A patient might talk about how unlucky they have been or how unfair life is. An REBT therapist would identify this as utopianism and challenge it as an irrantional belief:
- Empirical argument - disputing whether there is evidence to support the irrational belief
- Logical argument - disputing whether the negative thought acutally follows from the facts
As induviduals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms. The goal of treatment, is to work with depressed individuals to gradually decrease their avoidance and isolation, and icrease their engagement in acitivies that have been shown to improve mood.
Cognitive Approach - Treating Depression (3)
- There is a large body of evidence to support the effectivness of CBT for depression, e.g. March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents. After 36 weeks 81% of the CBT group, 81% of the antidepressent group and 86% of the CBT + antidepressents group were significantly improved. CBT emerged as just as effective as medication and helpful alongside medication.
- CBT may end up minimising the importance of the circumstances in which the patient is living (McCusker 2014). A patient living in poverty or suffering abuse needs to change their circumstances, and any approach that emphasises what is in the patient's mind rather than their environment can prevent this. CBT techniques used inappropriate can demotivate people to change their situation.
Biological Approach - Explaining OCD
Researchers have identified specific genes which create a vulnerability for OCD, called candidate genes.
- Seretonin genese, e.g. 5HT1-D beta, are implicated in the transmission of seretonin across synapses.
- Dopamine genes are also implicated in OCD
OCD is not caused by one single gene byt serveral are involved (polygenic) Taylor (2013) found evidence that up to 230 different genese may be involved in OCD.
One group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person (aetiologically heterogeneous)
Biological Approach - Explaining OCD (2)
Neurotransmitters are responsible for relaying information from one neuron to another. For example, if a person has low levels of serotonin then normal transmission of mood-relevent information does not take place and mood is affected.
Some cases of OCD. and in particular hoarding disorders, seem to be associated with impaired decision making. This in turn may be associated with abnormal function of the lateral frontal lobes of the brain.
There is also evidence to siggest that an area called the left parahippocampal gryus associated with processing unpleasent emotions, functions abnormally in OCD.
Biological Approach - Explaining OCD - Evaluate
- There is evidence from a variety of sources which suggests that some people are vulnerable to OCD as a result of their genetic make-up.
- Nestadt et al (2010) reviewed twin studies and found that 68% of identical twins (MZ) shared OCD as opposed to 31% of non-identical (DZ) twins.
- Twinstudies strongly suggest that OCD is largely genetic, but psychologists have been less successful at pinning down all the genes involved.
- One reason for this is that it appears that several genes are involved and that each genetic variation only increases the risk of OCD by a fraction.
- The consequence is that a genetic explanation is unlikely to ever be very useful because it provides little predictive value.
Biological Approach - Treating OCD
Drug theraoy for mental disorders aims to increase/decrease levels of neurotransmitters in the brain or to increase/decrease their activity. Low levels of serotonin are associated with OCD.
Selective Serotonin Reuptake Inhibitors prevent the reabsorption and breakdown of serotonin in the brain. This increases its level in the synapse and thus serotonin continues to stimulate the postsynaptic neuron.
A typical daily dose of Fluozetine is 20mg although this may be increased if it is not benefitting the patient. It takes 3-4 months of daily use for SSRIs to impact upon symptoms. This can be increased (e.g. 60mg a day) if this is appropriate
Drugs are often used alongside cognitive behaviour therapy to treate OCD. The drugs reduced a patient's emotional symptoms, such as feeling anxious or depressed.
Biological Approach - Treating OCD (2)
Tricyclics (an older type of antidepressant) are sometimes used, such as Clomipramine. These have the same effect on the serotonin system as SSRIs but the side-effects can be more severe
In the last five years a different class of antidepressant drugs called Serotonin Noradrenaline Reuptake Inhibitors have also been used to treat OCD. Liem tricyclics these are a second line of defence for patients who don't respond to SSRIs. SNRIs increase levels of serotonin as well as noradrenaline.
Biological Approach - Treating OCD - Evaluate
- A strength of drug therapy is tha it is effective at tackling OCD symptoms. For example, Soomro (2009) reviewed 17 studies comparing SSRIs to placebos in the treatment of OCD. All 17 studies showed significantly betweer results for SSRIs than for the placebo conditions. Effectiveness is greatest when SSRIs are combined with a psychological treatment, usually CBT. Typically symptoms reduce around 70% of patients taking SSRIs, the rest are helped by alternative drugs or CBT+drugs.
- Some cases of OCD follow trauma. Ocd is widely believed to be biological inorigin. It makes sense therefore that the standard treatment should be biological. However, it is acknowledged that OCD can have a ranfe of other causes, and that in some cases it is a response to traumatic life events. It may not be appropriate to use drugs when treating cases that follow a trauma when psychological therapies may provide the best option.