Psychopathology

Definitons Of Abnormaility-Statistical Infrequency

STATISTICAL INFREQUENCY--  Infrequency is where you have abnormal behaviour that is very rare,

^ STATISTICS means how common behaviours or traits are can be measured in comparison with rest of population, the most unusual ones are abnormal........

^ LOW IQ: defining someone who is two standard devisations from average, covers just 2.28% of population as an objective measure of individuals needing support

EVALUATION--

- Not all statistically infrequent traits are negative--- defintion includes individuals who have high IQ, as this is a statistically rare trait but highly desirable

-cut off point place results in some people reciving treatment and some now, where that cut of point is is subjective

-some psychopathologies are common, depression & anxiety.... 17% adults in England meet criteria for common mental disorder (2014)... definition doesnt include them

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Definitions Of Abnormaility-- Failure To Function

INHABILITY TO COPE WITH DAILY LIFE--- interacting with world & people around us in order to navigate everyday life can be demanding, some struggle to meet requirements

ROSEHAN & SELIGMAN (1989)-- 

- Maladaptive behaviour--- individuals behave in ways against long term interests

-Personal Anguish--- suffering anxiety & distress because of an inhability to cope

-Observer Discomfort--- A behaviour causes distress to people around them ( poor personal hygiene/ not respecting personal space )

-Irrationality & Unpredictability--- behaviour thats hard to understand

-Unconventionaility-- Behvaiours that go against normal expectations

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Definitions Of Abnormaility-- Failure To Function

EVALUATIONS--

- if individual is coping or not is often a subjective judgement- opinions of observer

- some abnormal behaviour isnt linked to an inability to cope or intense distress-- thought there are many psychopaths that may be more able to function in some roles in society

-Not all maladaptive behaviour is an indication of mental illness.... ( smoking & poor diet-- seen as against persons long term interest in personal health )

-Failure to function definiton respects and recognises the paitients own lived experience and perspective

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Definitions Of Abnormaility-- social norms

SOCIAL NORMS- are unwritten expectations of behaviours that may differ from culture to culture, often change over time & can vary in context

BREAKING NORMS-- people who deviate from societies expectations are often seen as abnormal or 'social devinats'

CULTURALLY SPECIFIC-- As norms as a group judge on what is acceptable, certain behaviours in one culture may be seen as acceptable but in anouther may be deviant (homeosexuality)

EVALUATION--

-respects cultural differences between societies by not impairing a set definition of abnormaility, not imposing a western ethnocentric view of abnormaility on other cultures

-can create problems for living in a culture different from thier culture of origin

-Can result in society imposing punishments to unconventional people expressing thei individualtiy

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Definitions Of Abnormaility- Mental Health

MAIRE JAHODA (1958)- humanist principles defining six features of ideal mental health.... suggesting that deviation from these features would indicate abnormaility

E- environmental mastery- competent in meeting demands of situations, flexible thinking

A- autonomy- able to act independently of others and rely on own abilities

R- resisting stress- able to cope with anxiety caused by demands of life

S- self actualisation- maximising personal growth and development to reach our potential

P- positive attitude to oneself- high self esteem, self respect ( hummanism term: positive self concept)

A- accurate perception of reality- realistic view of world not distorted by perosnal biases

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Definitions Of Abnormaility- Mental Health Pt2

EVALUATIONS:

- Positive holistic approach to diagnosis, identifies with personal development

-Criteria are culturally biased and reflect on ethnocentric western viewpoint on what ideal mental health is ( example of culturally specific perspective on mental health being incorrectly applied to all people as an universal or 'etic' construct.) 

- Criteria are too difficult to achieve, most people would be judged as failing to achive ideal mental health and therefore be abnormal

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Behavioural, Emotional, Cognitive- Phobias

BEHAVIOURAL-

Avoidance- behavioural adaptations made to avoid encountering phobic object or situation           Panic- uncontollable physical response of escaping, screaming, hyperventilating                           Failure To Function- inhability to conduct normal nescessary behaviours due to excessive thoughts

EMOTIONAL-

Anxiety- uncomfortable high arousal state that inhibits relaxation and pleasurable emotions, thoughts focused on a future encounter with phobic object                                                              Fear- intense emotional state of panic linked to psychological flight or fight response when presented with phobic object                               

COGNITIVE-

Irrational Beliefs-  sufferers overstate the potential danger of phobic object or importance              Reduced Cognitive Capacity- suuferer focuses attention on phobic object (interfers with things)                                                                                                                       

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Behavioural, Emotional, Cognitive-OCD

BEHAVIOURAL-COMPULSIONS-

Compulsions-checking behaviour ( repetedly testing lights etc)                                                           Avoidance- avoid behaviour that may lead to obsessive thoughts (avoid leaving house)                   Social Impairment- unable to take part in normal relationships due to excessive anxiety

EMOTIONAL-

Extreme Anxiety- caused by constant prescense of persistent obsessive thoughts & fear associated with them, attempting to resist urge to carry out compulsions result in anxiety                 Distress/Depression- low mood due to not engaging in enjoyable things, not in control

COGNITIVE-OBSESSIONS-

Recurrent Thoughts- intrusive unpleasent thoughts that anxiety producing (worst case-unlocked doors result in theft)                                                                                                                             Undertsand Irrationality- sufferers know worst case imagined by them thinking are very unlikely (still unable control)

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Behavioural, Emotional, Cognitive- Depression

BEHAVIOURAL-

Weight Loss- appetite reduced                                                                                                            Low Energy- desire to participate in normally enjoyable activities reduced                                         Self Harm- injuring, cutting, suicide                                                                                                     Poor Personal Hygiene- low motivation to keep themselves or environment clean        

EMOTIONAL-

Sadness- persistent intense lowered mood ( defining feature )                                                           Reduced Self Worth- feelings of guilt, helplessness, low self esteem

COGNITIVE-

Poor Concentration- difficulty in keeping concentration & indiciveness                                               Persistent Concern- thoughts are biased towards a negative persepctive of events or outcomes

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Behavioural Appraoch To Explaining Phobias

TWO PROCESS MODELbehaviourists see all behviour, including phobias as learnt via experience. MOMWRER (1960) suggests phobias are first learnt ( acquired ) via association (classicl conditioning) and then are maintained via reinforcement (operant conditioning)

ACQUISITION-CLASSICAL CONDITIONING / LEARNING BY ASSOCAIATION---- phobic objects are first a neutral stimulus (NS), not producing a phobic response. If presented with a unconditioned stimulus (UCS) that produces the unconditioned response (UCR) the NS will become associated with the UCS and now fear the phobia will happen whenever the NS appears. At this point the NS and CS, and the UCR is the CR.--- Can then be passed on to other stimuli via GENERALISATION

MAINTENANCE- OPERANT CONDITIONING / LEARNING BY TRAIL AND ERROR--- Avoiding situations that may bring the individual with the phobia into contact with phobic object has the consequence that anxiety is reduced. This is pleasent sensation and acts as negative ( removal of a negative stimulus )

SLT-- SLT theorists suggest learning can happen vicariously by observation of models. Observing the fear response of others can then result in the same display of fear especially if it results in a reward for the model ( attention )

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Behaviural Approach To Explaining Phobias pt2

EVALUATION--

-WATSON AND RAYNER (1920)-- little albert demonstrated how phobias could be induced in a child by making a load noise wehn presenting a rat to a child---fear was generalised to other objects

-MENZIES AND CLAKE(1993)-- when asked 2% of children with a fear of water could recall a traumatic experience with water. Suggesting the behaviourists explanation cannot accout for all phobias

-Phobis of snakes, birds and dogs could have an evolutionary origin, as our very early ancestors would have been hunted by these creatures. This could explain why these are a common phobia, when phobias of more dangerous objects, like knives are rare. This evolutionary biological theory however goes against the behavioural approach

-BEHAVIOURIST- phobia formation and maintenance have lead to effective counter conditioning treatments such as flooding and systematic desensitisation. supporting the behaviurist explanation

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Behavioural Approach To Treating Phobias PT3

SYSTEMATIC DESENSITISATION                                                                             BEHAVIOURAL THERAPIES-- phobias are learnt associations to fear, therapies attempt to replace the fear association with one of relaxation/calm

SYSTEMATIC DESENSITISATION-- attempt at using classical conditioning principles in a process to "counter codition" the phobia. Associating the phobic object with feelings of relaxation

The process assumes that fear and relaxation are two oppositie emotions, and if this is true then they cannot co-exist at the same time (reciprocal inhibition)

The first stae is the phobia is broken down into a anxiety hierarchy, from least feared presentation of the stimulus to the most feared

Relaxation techniques, such as breathing excersises are taught by the therapist--clients encouraged to relax at each stage in a stepped approach. This gradual exposure leads to the extinction of fear association and a new association with relaxation.

Bond between CS (bees) and CR (fear) must be broken by replacing the fear response with an antagonistic response----Relaxation

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Behavioural Approach To Treating Phobias-PT4

Flooding                                                                                                                           BEHAVIOURAL THERAPIES-phobias are learnt associations to fear, theories attempt to replace the fear association with one of relaxation/calm

FLOODING- an attempt to counter condition the phobia by immediate and full exposure to the max level of phobic stimulus............... this immediate exposure will cause temporary panic in client, while bombarded with fear, may attempt to escape to avoid phobic stimulus. Clinicians job is to prevent avoidance by stopping client from ending treatment.......... eventually temporary panic will stop and client will calm down, anxiety will have receded and fear will be extinguished due to exhaustion

COMPARISON                                                                                                                                  Systematic Desensitisation (SD) is often thought to be more successful than flooding as client is in control of thier progress, not therapist.

SD often higher completion rate than flooding, possibly cause its more pleasant experience due to focus on relaxation + resting from stimulus

Flooding not for old people, people with heart conditions or children due to ethical concerns (SD sutiable)

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Behavioural Approach To Treating Phobias-PT5

EVALUATION-

-While both SD and Flooding may be effective in clinicians setting, may be that effect is not generalised in outside world. Also possibly better at treating specific phobias than social

-Severe ethical concerns about protecting clients from emotional harm with flooding, end up reinforcing the phobia if treatment is ended too soon

-Alternatives for treatment of phobias exist, such as drug treatments. These are often used as a short term solution before talking therapies, as an anxiety disorder tranquilisers and beta blockers and anti-depressants can be prescribed, but have side effects

-SD may take a number of sessions to complete, and as a talking therapy requires 121 time with trained therapist resulting in substantial cost

-LANG AND LAZOVIK (1963)-- used systematic desensitisation on a group of college students suffering from snake phobias, after 11 sessions working through hierarchies and using hypnotism to help with relaxation, all participants fear reduced and remained low 6 months later

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Cognitive Approach To Treating Depression

DISTURBANCE OF THINKING- cognitive approach models sugest depression results from faulty cognitions/information processing/ negative thinking about events

SCHEMA-- say we have mental frameworks for objects that act as short cuts in understanding world, includes schemas about ourselves...Depression can result from our self-schemas being negative

BECKS NEGATIVE TRIAD-- events are seen with a pessimistic/negative bias due to the development of negative schemas about world, self and future. This can lead to overgeneralisation ( a problem in one situation being a problem in others ), magnification of problems ( seeing them as more important than they are ), selective perception ( focusing on negative ) and absolutist thinking ( all or nothing )

ELLIES ABC MODEL-- people respond in different ways to stresses and challenges in life, Ellis suggests this depends on thier beliefs...... ( A- acting event- external situation ) ( B- belief- why individual thinks A happened ) ( C- consequences- behaviour and emotions caused by B, A is blamed for unhappiness in depression )

MUSTERBATORY THINKING-- Ellis suggests thinking in absolutes, " the world must be perfect" -- common type of belief that leads to unhappiness

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Cognitive Approach To Treating Depression PT2

EVALUATION-

-HAMMEN AND KRANTZ (1976)-- found support for negative distortions in depressed female undergraduates compared to a control group when presented with a short story, with the depressed females showing more errors in logic when interreting the narrative

-Cognitive explanations for depression have been used to develop succesful and widely used psychological CBT/REBT treatments. The success of these treatments are shown by MARCH ET AT (2007) who compared CBT with medication and found and effectiveness rate of 81% for both treatments, suggests that the underling cognitive theory that depression is due to faulty cognitions is valid

-some depressive patients have manic phases, in which they exhibit a large amount of energy and confidence. Also many paitients have significant anger managment issues. Cogntive explanations struggle to explain these paitients 

-Placing responsibility for depression in hands of paitients to change could either empower the patient to help themselves, or potentially be a case of "blaming the victim", this could be the case especially if there are contributing situational factors like grieving or poverty.

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Cognitive Approach To Treating Depression PT3

COGNITIVE BEHAVIOURAL THERAPY (CBT)-- talking therapy that focuses on identifying and challenging irrational thoughts.. Activities are set to change behaviours

BECKS CBT: 16-20 week program focuses of present experience and issues                                  --Therapist trains thought catching, identiying and recording their automoatic negative/irrational thoughts. Once identified negative thoughts are challenged and reconstructed to avoid distortion due to negative triad                                                                                                                            --Patient acts as a scientist, hypothesis/ reality testing irrational thoughts by carrying out homework tasks, such as testing new ways of thinking and behaving and then evaluating the evidence.. Diaries may also be used.                                                                                                                   --Patients are encouraged to take part in enjoyable activities in a process called behavioural activation this improves emotions and challenges thoughts

ELLIS'S CBT (RATIONAL EMOTIVE BEHAVIOUR THERAPY-REBT)-- the ABC model developed  --ABCDE: D ( disputation of irrational beliefs) leading to E (effective change) added. Characterised by intensive disputation (arguing against) or the assumptions underling irrational beliefs.. these arguments can be either logical ( do beliefs make sense?) or empirical ( is there any evidence for these beliefs?)

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Cognitive Approach To Treating Depression PT4

EVALUATION--

-MARCH ET AL(2007)-- compared CBT with medication and in combination with medication found over 36 weeks in 327 participants. Finding both CBT alone and medication alone had a effectiveness rate of 81% and when combined 86% effectiveness...suggesting CBT is as effective as medication

-CBT is not appropriate for paitients who are severly depressed as theyre unwilling to engage with difficult psychological work

-16-20 sessions with trained proffesional is costly and takes up time, access is limited in a health survice with limited funds avaliable making CBt a less viable treatment compared to anti-depressants

-CBT could be empowering, own recovery...anti-depressants, passive role

-CBT has a positive impact on wider economy.. people being in more control of thier mental health results in fewer sick says and an improvement in productivity

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Biological Approach To Explaining OCD

GENETIC EXPLANATIONS-- OCD may be inherited, gene markers predict presence  INDIVIDUAL GENES-- gene 9, COMT and SERT seen to be present with OCD, however ther emay be as many as 230 seperate genes that may be involved in development of OCD meaning  disorder is polygenetic                                                                                                                               FAMILY STUDIES-- general population 2% have OCD, however among first degree relatives the figure is 10%, indicating a genetic basis.... Twin studies, also provide evidence with concordance rates among MZ twins as high as 87% (DZ 47%)                                                                  

NEURAL EXPLANATIONS-- changes in genes could impact functioning of neural systems         LOW LEVELS OF SEROTONIN- prevents the reptition of tasks and is in too low level, or removed too quickly from synaptic systems, before able to inhibit the repetition of an action this may result in obsessive thoughts                                                                                                   BASAL GANGLIA-- communication between this structure and others may be disrupted in OCD patients, observed OCD often occurs in people with parkinsons... linked to repetitive motor functions... cutting connection to frontal cortex can reduce symptoms in severe cases        OBSERVED IN OCD PAITIENTS-- excess activity in orbitofrontal cortex ( predicts future events and controls impulses from the limbic system) and abnormal activity in the parahippocampal gyrus (regulation of unpleasent emotions)

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Biological Approach To Explaining OCD PT 2

EVALUATION- 

-HU(2006) found genetic differnces between 169 OCD suuferers and 253 controls that impacted the function of serotnin transporters in brain... supporting genetic and nural explanations

-Family studies cannot fully control for the influence of shared environmental factors (diet) and SLT in thier methods... Conversations about/ awarness of OCD will become more common with a sufferer in household, making other family members seek treatment

-Drugs that work on serotonin system could simply cover up symptoms not treat the root cause

-Biologically determinist- OCD is due to uncontrollable gene and neural factors.. However cognitive explanations say OCD is due to fault information processing, by use of conscious thought in challenging irrational beliefs OCD symptoms can be reduced ( soft determinist view ) 

-Biologically reductionist- OCD is complex emotional experience.. Bio explanations ignore role of family, or cognitive explanations that also provide treatment and are based on more complex system of irrational thought processing

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Biological Approach To Explaining OCD PT3

DRUG THERAPY--chemical treatments that influence bio functioning of some aspect of body.. Mental health neurotransmitter systems are targeted

ANTI-DEPRESSANTS- inhibit feelings of anxiety (anxiolytics). But these drugs may need to be taken for a number of months (3-4) before effective

SEROTONIN-- low levels are associated with both obsessions and compulsions, OCD drug treatments mainly target ( select ) the serotonin re-uptake system

SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS-SSRI'S-- fluoxetine (prozac) is most common example.. SSRI'S inhibit the re-uptake/ absorption of serotonin which is too fast in people with OCD, this results in serotonin staying in the synaptic cleft for longer, remaning active in influencing the post-synaptic neuron

ALTERNATIVES TO SSRI-- non selctive re-uptake drugs are used (Tricyclics-clomipramine) or SNRI'S that influence noradrenaline-- often second choice

PSYCHOSURGERY- allows communication between orbital frontal cortex andother areas of brain, or new experimental techniques include deep brain stimulation, electroses placed in brain

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Biological Approach To Explaining OCD PT4

EVALUATION--

- Meta-analyis by GREIST ET AL (1995) reviwed placebo-controlled trails of effects of four drugs on OCD.. All 4 were more effective than placebo... with clomipramime the most effective    (fluoxetine, fluvoxamine. sertaline )  

-publication bias- been shown that positive results are more likely to be published than negative, this is because drug companies have financial incentive to show drug effective

-drug therapies can produce side effects, insomnia and nausea... When patient stops taking them, SIMPSON(2004) found relapse in 45% of cases within 12 weeks--compared to 12% of cases for CBT paitients.. suggestings drigs dont treat OCD

-Cognitive neuroscience now producing bio treatments that invlove direct brain stimulation using electrodes in affected areas to reduce the presence of obsessions-- hoped these treatments may take the place of drugs in severe cases

-Bio drug therapy cost is cheap in comparison to cognitive treatments (CBT) and require less effort to administer... may lead to drug therapies being prefered treatment

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