Psychopathology

Behavioural:

• A phobic may panic in response to presence of phobic stimulus (may include crying, running away) Children may react differently (freezing, clinging)
• Phobics tend to avoid the phobic stimulus, can make it hard to go about daily life
• A phobic remains in the presence of the stimulus but continues to experience high levels of anxiety - may be unavoidable in some situations

Emotional:

• Emotional response of anxiety or fear. Anxiety is an unpleasnant state of high arousal - prevents phobic relaxing making it difficult to experience positive emotions. Fear is the immediate response to phobic stimulus - anxiety can be long term
• Emotional responses to phobic stimulus are unreasonable

Cognitive:

• If a phobic can see the stimulus it is hard to look away
• A phobic may hold irrational beliefs in reaction to the stimulus - increases pressure
• Phobic's perceptions of the stimulus may be distorted

Activity Levels:

• Sufferers have reduced levels of energy, making them lethargic. This leads to wthdrawing from work, education + social life - sometimes sufferes cannot get out of bed (exreme)
• Depression can lead to the opposite effect - psychomotor agitation (strugling to relax)

Disruption to Sleep and Eating Behaviour:

• Depression associated with changes to sleeping behaviour - may experence insomnia, particularly premature waking, or an increased need for sleep (hypersomnia)
• Appetite and eating may increase or decrease - weight gain/loss

Agression and Self-harm:

• Sufferers often irritable - can become verbally/physically aggressive - knock-on effects in certain aspects of life
• Depression can also lead to physical aggression directed against the self e.g. self-harm

Lowered Mood:

• Lowered mood is a defining emotional element of depession but it's more pronounced than the daily kind of experience of feeling lethargic and sad
• Patients often describe themselves as worthless or empty

Anger:

• Sufferers tend to experience more negative emotions and fewer positive ones
• Sufferers frequently experience anger - directed at self or others
• On occasion emotions lead to aggressive or self harming behaviour

Lowered Self-Esteem:

• Self-esteem is the emotional experience to how much we like ourselves
• Sufferers tend to report reduced self-esteem
• This can be quite extreme - some sufferers experience self-loathing i.e. hating theselves

Poor Concentration:

• Depression associated with poor levels of concentration
• Sufferer may find themselves unable to stick with a task or they may find it hard to make descisions usually staright forward
• Poor concentration and descision making likely to interfere with the individual's work

Attending to and Dwelling on the Negative:

• Sufferers are inclined to pay more attention to negative aspects of a situation and ignorehe positives
• Sufferers also have a bias towards recalling unhappy events rather than happy ones

Absolutist Thinking:

•  Most situations aren't all goodor all bad, when a sufferer is depressed they tend to think in these terms
• This is called 'black and white thinking' - wen a situation is unfortunate it is an absolute disaster

Compulsions:

• Compulsions are repetitive - typically sufferers feel compelled to repeat a behaviour e.g. hand washing
• Compulsions reduce anxiety - 10% of sufferers show compulsive bahaviour alone, no obsessions just irrational anxiety
• For the vast majority compulsive behaviours are performed to manage the anxiety produced by obsessions e.g. compulsive hand washing due to an obsessive fear of germs

Avoidance:

• Sufferers attempt to reduce anxiety by avoiding situations that trigger it e.g. avoiding coming into contact with germs
• This avoidance can lead sufferers to avoid ordinary situations, interfering with leading a normal life

Anxiety and Distress:

• OCD a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions
• Obsessive thoughts are unpleasant and frightening - anxiety that goes with these can be overwhelming - the urge is to repeat a behaviour creates anxiety

Accompanying Depression:

• OCD often accompanied by depression - anxiety can be accompanied by low mood and lac of enjoyment in activities
• Compulsive behaviour tends to bring som relief from anxiety - temporary

Guilt and Disgust:

• OCD sometimes involves other negative emotions such as irrational guilt e.g. over minor moral issues directed against somethimg external, like dirt

Obsessive Thoughts

• For around 90% of sufferers the major cognitive feature is obsessive thoughts
• They are always unpleasant but vary from person to person e.g. fears of being contaminated by dirt

Cognitive Strategies to Deal with Obsessions

• People respond to obsessions by adopting cognitive coping strategies
• This may help mange anxiety but can make the person seem abnormal to others distracting them from everyday tasks

Insight into Excessive Anxiety

• Sufferers are aware that their obsessions and compulsions are irrational - necessary for diagnosis
• Sufferers experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified
• They also tend to be hypervigilant i.e. maintain constant alertness and keep attention focused on potential hazards

Aquisition by Classical Conditioning

• Learning to associate something with no fear with something that triggers a fear response
• Watson and Rayner (1920) created a phobia in 9 month old boy - 'Little Albert'
• When Albert was shown a white rat he began to play with it - experimenters set out to give him a phobia
• Whenever the rat was present a loud and frightening noise was made by banging an iron bar close to Albert's ear
• he noise is an unconditioned stimulus which creates an uncnditioned response of fear
• The neutral stimulus (the rat) becomes associated with the UCS, both now producing the fear response
• The rat is now a conditioned stimulus that produces a conditioned response (fear) - Little Albert showed distress to all furry objects from then on

Maintenance by Operant Conditioning

• Operant conditioning takes place when a behaviour is reinforced or punished
• Reinforcement tends to increase the frequency of a behaviour
• In the case of negative reinforcement an individual avoids a situation that is unpleasant - the behaviour results in a desirable consequence - behaviour will be repeated
• Whenever we avoid a phobic stimulus we successfully escape the fear and anxiety we would've suffered - reinforces avoidance behaviour so maintains phobia

Good Explanatory Power

• Explained how phobias could me maintained over time - important implications for therapies because it explains why patients need to be exposed to fear stimulus
• Once a patient is prevented from avoiding the stimulus the behaviour ceases to be reinforced so declines - application to therapies a strength of the 2 process model

Alternative Explanations

• Genetics - people differ genetically, some may acquire genes making it more likely they will acquire a phobia - Torgesen (1983)
• Social Learning - Phobias may be acquired vicariously by imitation, people observe models showing fear of an object/situation - may aquire a phobia from this - Mineka

An Incomplete Explanation of Phobias

• Bounton (2007) points out that evolutionary factors probably have an important role in phobias - 2 process model doesn't mention this
• It is adaptive to aquire fears such as the dark and snakes - Seligman (1971) called this biological preparedness
• Preparedness is a problem for the 2 process model as it shows there is more to acquiring phobias than simple conditioning

• Systematic Desensitisation
• A behavioural therapy designed to gradually reduce phobic anxiety through classical conditioning
• A new response to the phobic stimulus is learned  (counterconditioning)
• The anxiety heirarchy: put together by patient and therapist - a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening
• Relaxation: therapist teaches the patient to relaxas deeply as posible - may involve breathing exercises or learning mental imagery techniques - patients can be taught to imagine themselves in relaxing situations or they may learn meditation
• Exposure:  the patient is exposed to the phobic stimulus while in a relaxed state - this takes several sessions starting at the bottom of the anxiety heirarchy - when the patient can stay relaxed they move up the heirarchy - treatment successful when patient can stay realxed throughout the anxiety heirarchy
• Flooding
• Involves immediate exposure to a very frightening situation - flooding sessions are much longer than SD but sometimes only 1 is needed
• The patient cannot avoid the phobic stimulus and they quickly learn that it is harmless - extinction
•  A learned response is extinguished when the CS is encountered without the UCS - CS no longer creates CR
• Flooding is very unpleasant but it isn't unethical as the patient gives fully informed consent - they are always fully prepared for the experience

• It's effective - Gilroy et al (2003) followed up 4 patients who'd been treated for a spider phobia in 3 45min sessions of SD - control group was treated by relaxation without exposure - at 3 and 33 months after treatment SD wer less fearful than relaxation group
• Strength as it shows that SD is helpful in reducing the anxiety in spider phobia and the results were long lasting
• It's Suitable for a Diverse Range of Patients - Other therapies aren't well suited to some patients e.g. those with learning difficulties - they can make it hard to understand what is happening in flooding or engage with cognitive therapies
• It is Acceptable to Patients - Patients tend to prefer SD beacuse it isn't traumatising and teaches you how to relax - reflected in low refusual rate and low drop out rates
• It's Cost Effective - flooding is at least as effective as other treatments and is a lot quicker - patients are free of symptoms faster making therapy cheaper
•  It's Less Effective for Some Types of Phobia - appears to be less effective for phobias like social phobias, possibly because they have cognitive aspects - these phobias may benefit more from cognitie therapies as they tackle irrational thinking
• Treatment is Traumatic for Patients - it is a highly traumatic experience and patients are often unwilling to se it through until the end - limitation of flooding because time and money are sometimes wasted preparing patients for treatment and then have them not start or continue

Beck

• Faulty Info Processing - when depressed people ignore positives and focus on the negative aspects of the situation - also tend to blow small problems out of proportion - black and white terms
• Negative Self-Schemas - a schema is a package of ideas and info developed through experience - they act as a framework for the interpretation of sensory info - a self-schema is the package of info we have about ourselves - negative self-schema means interpreting all info about ourselves negatively  
• The Negative Triad - 1) Negative view of the world -creates impression that there is no hope   2) Negative view of the future - reduce hopefulness and enhance depression 3) Negative view of the self - confirm the existing emotions of low self-esteem

Ellis

• Depression, in Ellis' theory, comes from having irrational thoughts - those with good mental health had rational thoughts   
• A - Activating Event - irrational thoughts triggered by an external event e.g. failing an exam
• B - Beliefs - He called the belief that we must always succeed 'musturbation'. The belief that it's a disaster when something doesn't run smoothly is 'I-can't-stand-it-itis' and 'Utopianism' is a belief that life is always meant to be fair
• C - Consequences - When an activating event triggers irrational beliefs there are emotional and behavioural consequences 

• Good supporting evidence
• Grazioli and Terry (2000) assessed 65 pregnant womenfor cognitive vulnerability and depression before and after birth
• They found that those womn judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression
• Clark and Beck (1999) reviewed research on this topic and concluded that there was solid support for all cognitive vulnerability factors - these cognitions can be seen before depression develops suggesting Beck is correct in saying that cognition cases depression
• It Has a Practical Application in CBT
• Beck's cognitive explanation forms the basis of CBT - all cognitive aspects of depression can be identified and challenged in CBT
• These also include the components of the negative triad that are easily identifiable - this means a therapist can challenge them and encourage the patient to test whether they are true
• This a strength as it translates well into a successful therapy
• It Doesn't Explain All Aspects of Depression
• Beck's theory explains the basic symptoms of depression but it is very complex - some patients are deeply angry and Beck cannot explain this extreme emotion
• Some also suffer hallucinations and bizarre beliefs - Beck's theory can't easily explain this

A Partial Explanation

• No doubt that some cases of depression follow activating events - psychologists call this reactive depression and see it as different from the kind of depression that arises withot an obvious cause
• This means Ellis' explanation only applies to some kinds of depression and is therefore only a partial explanation for depression

It Has a Practical Application in CBT

• The idea that, by challenging irrational negative beliefs, a person can reduce their depression is supported by research evidence (Lipsky et al 1980)
• This supports the basic theory as it suggests that the irrational beliefs had some role in the depression

It Doesn't Explain all Aspects of Depression

• Ellis explains why people appear to be more vulnerable to depression than others as a result of their cognitions 
• His theory doen't explain the anger associated with depression or the fact that some patients suffer hallucinations and delusions 

• CBT is the most commonly used psychological treatment for depression - it's most likely a clinical psychologist will offer it as the treatment
• CBT begins with an assessment in which the patient and cognitive behaviour therapist work together to clarify the problems - they jointly identify goals for the therapy and put together a plan to achieve them
• One of the central tasks is to identify where there might be negative/irrational thoughts that will benefit from the challenge
• CBT then involves working to change negative/irrational thoughts and put effective behaviours in place
• Beck's Cognitive Therapy
• The idea to CBT is to identify automatic thoughts about the world, self and the future - once identified these have to be challenged
• Homework is usually set e.g. writing down everything positive that has happened - the patient is investigating their own negative thoughts
• Ellis' Rational Emotive Behaviour Therapy
• Extends the ABC model to an ABCDE model - the D = dispute and the E = effect
• The central technique of REBT is to identify and dispute irrational thoughts
• REBT often involves vigorous arguments and the intended effect is to chane the irrational belief and break the link between negative life events and depression
• Ellis identified different ways of disputing irrational thoughts
• Behavioural activation will provide more evidence for the irrational nature of beliefs

• It's Effective
• March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the 2 in 327 adolescents with a main diagnosis of depression
• After 36 weeks 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved
• CBT emerged as effective as medication and helpful alongside it - suggesting a good case for making CBT the first choice of treatment in public health care systems
• CBT May Not Work For The Most Severe Cases
• In some cases depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT - may not be able to pay attention
• Where this is the case it's possible to treat patients with antidepressant medication and commence CBT when they're more alert and motivated
• This is a limitation of CBT as it means it cannot be used as the sole treatment for all cases
• Success May Be Due To The Therapist-Patient Relationship
• Rosenzweig (1936) suggested that the difference between CBT and systematic desensitisation might actually be quite small
• All psychotherapies share one essential factor - the therapist-patient relationship - it may be the quality of this relationship that determines success rather than any particular technique
• Many comparative reviews find very small differences - supports the view that simply having an opportunity to talk to somone who'll listen could be what matters most

• Genetic Explanations
• Genes are involved in individual vulnerability to OCD - Lewis (1936) observed that of his OCD patients 37% had parents w/ OCD and 21% had siblings w/ OCD - suggesting it runs in the family
• What is probably passed on from 1 generation to the next is the genetic vulnerability and not the certainty of OCD
•  Diathesis-stress model - certain genes leave some people more likely to suffer a mental health disorder but it isn't certain - environmental stressors are necessary to trigger the condition
• Candidate Genes
• Researchers have identified genes, which create vulnerability for OCD, called candidate genes
• Some of these are involved in regulating the development of the seretonin system
• OCD is Polygenic
• OCD is not caused by a single gene but by several that are involved
• Taylor (2013) analysed findings obvious studies and found evidence that up to 230 different genes may be involved in OCD - including those associated w/ the action of dopamine and seretonin
• Different Types of OCD
• 1 type of genes may cause OCD in 1 person but a different group may create the same disorder in another person
• Aetiologically heterogeneous - the origin of OCD has different causes
• Aso some evidence that different types of OCD may be the result of particular genetic variations

Neural Explanations

• Genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain

The Role Of Seretonin

• Neurotransmitters are responsible for relaying info from 1 neuron to another
• If a person has low levels of seretonin then normal transmission of mood-relevant info doesn' take place and mood (sometimes other mental processes) are affected
• At least some cases of OCD are explained by a reduction in th functioning of the seretonin system in the brain

Decision-making Systems

• Some cases of OCD (particularly hoarding) seem to be associated w/ impaired decision making - this may be associated w/ abnormal functioning of the lateral of the front lobes of the brain
• The frontal lobes are he frontal parts o the brain that are responsible for logical thinkingand making decisions
• There is also evidence to suggest that the parahippocampal gyrus, associated w/ procesing unpleasant emotions, functions abnormally in OCD 

There is Good Supporting Evidence

• Evidence from a variety of sources fo the idea that some people are vulnerable to OCD as a result of their genetic make-up
• One of the best sources of evidence is twin studies - Nestadt et al (2010) reviewed previous twin studies and found that 68% of MZs shared OCD as opposed to 31% of DZs - strongly suggests genetic influence of OCD

Too Many Candidate Genes

• Psychologists have been less successful in pinning down the genes involved in OCD - one reason is beacuse several genes are involved and that each genetic variation only increases the risk of OCD by a fraction
• Consequence is that a gentic explanation is unlikely to ever be very useful as it provides little predictive value

Environmental Risk Factors

• Environmental factrs can also trigger or increase the risk of developing OCD - the diathesis-stress model
• Cromer et al (2007) found that over half the OCD patients in their sample had a traumatic event in their past - OCD more sever in those w/ more than 1 trauma
• Suggests OCD cannot be entirely genetic in origin - may be more productive to focus on the environmental causes (more able to do something about them)

• There is Some Supporting Evidence
• There's evidence to support the role of some neural mechanisms in OCD - some antidepressants work purely on the seretonin system increasing levels of the neurotransmitter
• Such drugs are effective in reducing OCD symptoms suggesting seretonin is involved
• OCD symptoms form parts of other coditions that are biological in origin e.g. Parkinson's Disease - suggests that biological processes causing symptoms in those conditions may also be the cause of OCD
• It Isn't Clear Exactly What Neural Mechanisms Are Involved
• Studies of decision making have shown that these neural systems are the same systems that function abnormally in OCD
• Research has also identified other brain systems that may be involved sometimes - no system has been found that always plays a role in OCD
• We can't therefore claim to understand the neural mechanisms involved in OCD
• We Shouldn't Assume the Neural Mechanisms Cause OCD
• There's evidence to suggest that various neurotransmitters and structures of the brain do not function normally in patients w/ OCD
• This isn't the same as saying that this abnormal functioning causes OCD - biological abnormalities could be a result of OCD rather than a cause

• SSRIs - Selective Seretonin Reuptake Inhibitors
• Standard medical treatment for OCD involves a SSRIs (a particular type of antidepressant) - SSRIs work on the seretonin system in the brain
• Seretonin is released by  presynaptic neurons in the brain and travels across a synapse - the neurotransmitter chemically conveys the signal from the presynaptic nerve to the postsynaptic nerve - the it's reabsorbed by the presynaptic nerve where it's broken down and reused
• By preventing reabsorption and breakdow of seretonin SSRIs effetively increase it's levels stimulating the postsynaptic neuron
• A typical daily amount of Fluoxetine (prozac) is 20mg - increased if symptoms are worse - takes 3-4 months for drugs to have impact
• Combining SSRIs w/ Other Treatment
•  Drugs often used alongside CBT to traet OCD - drugs reduce a patients emotional symptoms meaning they can engage more effetively w/ CBT
• Alternatives to SSRIs
• Where an SSRI is not effective after 3-4 months the dose will be increased or can be combined w/ other drugs
• Other antidepressants are tried - patients respond differently to different drugsand alternatives work well for some but not for others
• Tricylcics or SNRIs (seretonin noradrealine reuptake inhibitors) are often used as alternatives

• Drug Therapy is Effective at Tackling OCD Symptoms
• Clear evidence for the effectiveness of SSRIs in reducing severity of OCD symptoms and improving quality of life for OCD patients
• Soomro et al (2009) reviewed studies comparing SSRIs to placebos in the treatment of OCD and concluded that al 17 studies reviewed showed significantly better resuts for the SSRIs than the placebo conditions
• Effectiveness is greatest when SSRIs are combined with a psychological treatment - typically symptoms declined for around 70% patients taking SSRIs - the 30% alternative drug treatments or combinations will be efective for some
• Drugs are Cost-Effective and Non-Disruptive
• Drugs are generally cheap compared to psychological treatments - using drugs to treat OCD is good value for public health systems e.g. NHS
• SSRIs also non disruptive to patients' lives - you can take drugs until symptoms decline and no engage w/ had work of CBT
• Drugs Can Have Side Effects
• A significant minority will get no benefit from SSRIs - side effects are also suffered e.g. indigestion, blurred vision and loss of sex-drive
• Those taking Clomipramine (tricyclic) side effects are more common and can be serious - 1/10 suffer weight gain and tremors - 1/100 suffer disruption to blood pressure and become aggressive
• These factors reduce effectiveness as people stop taking medication    

• Statistical Deviation
• Any relatively usual behaviour or characteristic can be thought of as 'normal', any behaviour different to this is 'abnormal'
• Statistical approach comes into it's own when looking at characteristics that can be reliably measured e.g. intelligence
• In any human characteristic the majority of people's scores will cluster around an average - the further above or below the fewer people gaining that score
• Average IQ is 100 - 68% have an IQ in between 85-115 - only 2% score below 70 and these individuals are classed as 'abnormal' (intellectual disability disorder)
• Real-Life Application
• In the diagnosis of intellectual disability disorder. A place for statistical deviation in normal/abnomal behaviours - a useful part of clinical assessment
• Unusual Characteristics Can Be Positive
• IQ scores over 130 as unusual as those below 70 but we don't see anything abnormal about this. It makes it abnormal but not requiring treatment - limitation as it cannot be used alone to make a diagnosis
• Not Everyone Unusual Benefits From a Label
• When someone is living a fulfilled life there's no benefit in them being labelled as abnormal. Someone w/ a low IQ but who wasn't distressed wouldn't need a diagnosis of intellectual disability - being labelled as abnormal may have a negative effect on their life

• Most of us notice whose behaviour deviates from social norms - groups of people choose to define behaviour as abnormal on the basis that it isn't acceptable or the norm
• Social norms may be different for each culture and generation - relatively few behaviours that ae universally abnormal e.g. homosexuality is still considered abnormal in some cultures
• A person w/ antisocial personaloty disorder is impulsive, aggressive and irresponsible - making a social judgement that a psychopath is abnormal because they don't conform to moral standards
• Not a Sole Explanation
• A strength of deviation from social norms is that it has a real-life application in the diagnosis of psychopathy
• There are factors to consider though e.g. the distress to others that psychopaths cause - devition from social norms never the sole reason for abnormality
• Cultural Relativism
• Social norms vary, through generations and cultures - a person from 1 culture may label someone from another as abnormal according to their standards
• Creates problems for people from one culture living within another
• Can Lead to Human Rights Abuse
• Too much reliance on deviation from social norms can lead to systematic abuse of human rights
• Historically, diagnosis were there to control minority groups and women - appear ridiculous nowadays as social norms have changed

• A person may be classed as abnormal when they cannot cope w/ the demands of everyday life
• Someone may not be functioning adequately when they aren't able to maintain basic standards of hygeine and nutrition - or if they can't hold a job or maintain relationships
• Rosenhan and Seligman (1989) proposed signs that can be used to determin if someone isn't coping - 1) when a person no longer conforms to interpersonal rules 2) when a person experiences severe personal distress 3) when a person's behaviour becomes irrational or dangerous to themselves and/or others
• A person must be failing to function adequately before a diagnosis for intellectual disability disorder is given
• Patient's Perspective
• A strength is that it attempts to include subjective experience of the individual
• It's difficult to assess distress but this definition acknowledges patient's experiences as important - useful for assessing abnormailty
• Is It Simply Deviation From Social Norms
• Hard to say when someone is failing to function adequately and when they are deviating from social norms - treating behaviours which may be seen as strange risks limiting personal freedom and discriminating against minorities
• Subjective Judgements
• Someone has to judge whether a patient is distressed or distressing - there are methods for making judgements as objective as possible i.e. checklists
• The principle remains that someone has the right to make the judgement

• Once we have a picture of what is psychologically healthy we can begin to look at who deviates from this - making them abnormal
• Jahoda (1958) suggested we are in good mental helath if we follow the criteria
  1) No symptoms/distress                           2) Are rational and can percieves ourselves accurately
  3) We self-actualise                                   4) We can cope w/ stress
  5) We have a realistic view of the world    6) We have good self-esteem and lack guilt
  7) We're independent of others                 8) We can succesfully work, love and enjoy our leisure
• It's a Comprehensive Definition
• Strength = comprehensive - covers a broad range of criteria for mental health, probably covers most reasons someone would seek/recieve help
• Cultural Relativism
• Some ideas from Jahoda's classification are specific to W. European and N. American cultures - e.g. in some cultures self-actualisation would be considered self-indulgent (emphasis on individual as opposed to family/community)
• Sets an Unrealistically High Standard For Mental Health
• Very few attain Jahoda's criteria for mental health - this approach would see almost everyone as abnormal
• Positive - makes it clear to people the ways they can benefit from seeking treatment - negative - has no value in thinking about who might benefit from treatment against their will