Psychopathology

Statistical infrequency - occurs when an individual has a less common characteristic, for example being more depressed or less intelligent than most of the population (it goes against the normal distribution). If your IQ is below the normal distribution you will be declared to have an intellectual disability disorder.

Deviation from social norms - concerns behaviour that is different from the accepted standards of behaviour in a community or society, (goes against the collective judgement). Norms are specific to the culture that we live in (not likely to be universally abnormal). An example of deviation from social norms is antisocial personality disorder, and according to the DSM-5 (manual used to diagnose mental disorders) this is abnormal because it doesn't conform to our moral standards.

Failure to function adequately - occurs when someone is unable to cope with ordinary demands of day-to-day living. According to Rosenhan and Seligman someone is failing to function adequately when they no longer conform to standard interpersonal rules (such as maintaining eye contact and respecting personal space), they experience severe personal distres or their behaviour becomes irrational or dangerous. An example is intellectual disability disorder.

Deviation from ideal mental helath - occurs when someone does n9ot meet a set of criteria for goood mental health. Marie Jahoda suggested people are in good mental health if they: have no symptoms or distress, they are rational and percieve themselves accurately, self-actualise (reach potential), can cope with stress, have realistic views of world, have good self-esteem and lack guilt, are independent, and can successfully work, love and enjoy our leisure.

SI - Real-life application - it is a useful part of clinical assessment; it has a real-life application in the diagnosis of intellectual disability disorder.

SI - Unusual characteristics can be positive - high IQ scores are just as unusual as low ones, it is statistically abnormal. But, it wouldn't be thought of as an undesirable characteristic that needs treatment.

SI - Not everyone unusual benefits from a label - if someone is living a happy and fulfilled life, there is no benefit to them being lableed as abnormal.

DSN - Not a sole explanation - has same strength of SI on basis of diagnosis. But, there are other factors to consider such as distress caused to others by people who fail to function adequately.

Cultural relativism - social norms vary between cultures and generations.

Can lead to human rights abuses - maintains control over minority groups.

FFA - Patients perspective - captures experience of people with mental distress problems; so its useful for assessing abnormality.

FFA - Is it simply a deviation from social norms? alternative lifestyles or doing extreme sports may be examples of both (and they could be accused of behaving in a maladaptive way).

FFA - Subjective judgements - some patients may say they are distressed but be judged as not suffering.

DIMH - Comprehensive definition - it covers a broad range of criteria for mental health.

DIMH - Cultural relitavisim - same as deviation form social norms.

DIMH - Unrealistic high standard for mental health - very few people are constantly achieving all the criteria.

Phobia - an irrational fear of an object or situation.

DSM-5 categories of phobia - All phobias are characterised by excessive fear/anxiety triggered by an object, place or situation. 

Specific phobia - a phobia of an object or situation, such as an animal/body part, and flying/injections. 

Social anxiety/phobia is a phobia of a social situation, such as publuic speaking/public toilets.

Agoraphobia is the phobia of being outside or in a public place.

Behavioural - ways in which people act.

Panic - they may panic in response to the presence of a phobic stimulus; panic may involve behaviours such as crying, screaming or running away. Children may freeze, cling, or have a temper tantrum.

Avoidance - they go to a lot of effort not to come into contact with their phobic stimulus; making it hard to go about day to day life.

Endurance - the alternative to avoidance; they remain in the presence of the phobic stimulus but still experience high levels of anxiety.

Emotional - ways in which people feel.

Anxiety - phobias are classed as anxiety disorders, and they involve an emotional response of anxiety and fear.

Example: arachnophobia - anxiety levels will increase when going into a place associated with spiders, when they actually see a spider they will experience fear.

Emotional responses are unreasonable - the strong emotional response can be wildly disproportionate to the danger posed by the phobic stimulus.

Cognitive  - refers to the process of thinking - knowing, percieving, believing.

Selective attention to the phobic stimulus - it is hard to look away from the phobic stimulus; this is good because it gives us a good chance of survivial. Unless the fear is irrational, e.g. someone with pognophobia will struggle to concentrate on what they're doing if they see someone with a beard.

Irrational beliefs - e.g. social phobias can invlove beliefs like "I must always sound intelligent" or "if i blush people will think I'm weak". This increases the pressure on the sufferer.

Cognitive distortions - e.g. an omphalophobic is likely to see belly buttons as ulgy/disgusting, when they don't acutally look that bad, so their perceptions aren't distorted.

Depression - a  mental disorder characterised by low mood and energy levels.

DSM-5 categories of depression - major depressive disorder (severe but often short term), persistent depressive disorder (long term/ reccuring), desruptive mood dysregulation disorder (childhood temper tantrums), premenstrual dysphoric disorder (disruption  to mood due to menstruation).

Activity levels - reduced levels of energy making them lathargic, in some cases the opposite is true this is known as physchomotor agitation (struggle to relax).

Disruption to sleep and eating behaviour - may experience reduced sleep (insomnia) or an increased need for sleep (Hypersomnia), similarly, appetite/ eating may increase/ decrease leading to weight loss/ gain.

Aggression and Self Harm - They're often irritable and can become verbally or physically aggressive, can also lead to physical agreesion directed against the self.

Emotional - 

Lowered mood - patients may feel worthless and empty.

Anger - can be directed at the self or others.

Lowered self-esteem - they may experience a sense of self-loathing.

Cognitive - 

Poor concentration - may find it hard to concentrate on certain tasks.

Attending to and dwelling on the negative - pay more attention to the negative, e.g. glass is half empty rather than half full.

Absolutist thinking - everything is either black or white, there are no grey areas.

OCD - characterised by either obsession (recurring thoughts, images. etc) and/or compulsions ( repetitive behaviours such as handwashing).

DSM-5 categories of OCD - OCD, trichotillomania (compulsive hair pulling), hoarding disorder (compulsive gathering of possessions and the inability to part with anything, excoriation disorder (compulsive skin picking).

- cycle of OCD

Compulsions -

Compulsions are repetitive - feel compelled to repeat certain behaviours such as hand washing.

Compulsions reduce anxiety - around 10% of OCD sufferers show only compulsive behaviours. But the vast majority of compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions. The compulsion is in response to the obsessive thought.

Avoidance - attempt to reduce anxiety by keeping away from situations that trigger it, e.g. sufferers who wash compulsively may avoid coming into contact with germs.

Emotional (E) - Anxiety and Distress - OCD is an unpleasant emotional experience and the anxiety can be overwhleming.

E - Accompanying Depression - anxiety cna be accompanied by a low mood and lack of enjoyment in activities.

E - Guilt and Disgust - Negative emotions like irrational guilt; e.g. over minor moral issues, or disgust directed at something external, like dirt or at the self.

Cognitive (C) - Obssesive Thoughts - Around 90% of OCD sufferers have this.

C - Cognitive Strategies to deal with obessions - doing something they think will help.

C - Insight into an excessive anxiety - OCD sufferers are aware that there obsessions aren't rational but they still experience catastrophic thoughts about the worst case scenarios. They also tend to be hypervigilant.

The two-process model - The behavioural approach is a way of explainig  behaviour based on what is observable. Hobart Mowrer proposed this model and it states that phobias are aquired due to classical conditioning, and then continue due to operant conditioning.

Acquisition by classical conditioning - Wason and Rayner created a phobia in baby called 'litle albert',  to create the phobia of rats, everytime albert saw a rat they would create a really loud noise to scare him. Noise = unconditioned stimulus, fear = unconditioned response. Rat = conditioned stimulus when associated with noise, and fear = conditioned response. The conditioning then generalised to similar furry objects.

 Maintenance by operant conditioning - whenever we avoid a phobic stimulus we successfully escape the fear and anxiety. This reduction in fear reinforces the avoidance behaviour and so the phobia is maintained.

Good explanatory power - explained how phobias can be maintained overtime, and explained why in  therapy patients need to be exposed to the feared stimulus.

Alternative explanation for avoidance behaviour - some avoidance behaviour appears to be motivated more by positive feelings of safety, e.g. people who are agoraphobic are able to leave the house with a trusted person because they aren't alone. This is a problem for the two-process model, because it goes against the idea that avoidance is motivated by anxiety reduction.

An incomplete explanation of phobias - Bounton points out that evolutionary factors probably have an important role in phobias. Such as a fear of the dark. Seligman called this biological preparedness, and it shows that there is more to aquiring phobias than simple conditioning.

Systematic desensitisation (SD) - behavioural therapy designed to gradually reduce phobic anxiety through classical conditioning. It is impossible to relax while feeling anxiety (reciprocal inhibition), so the sufferer needs to be able to relax in the presence of the phobic stimulus - the learning of a different response (relaxation instead of anxiety) is called counterconditioning. 

The anxiety hierarchy - put together by patient and therapist (list of situations relating to phobic stimulus ranging from least to most frightening).

Relaxation - teaching patient to relax aas deeply as possible, e.g. breathing exercises and mental imagery techniques.

Exposure - patient is exposed to phobic stimulus while in a relaxed state (working way through different levels of anxiety hierarchy). They need to be able to stay relaxed at all levels.

Flooding - behavioural therapy in which a phobic patient is exposed to an extreme form of a phobic stimulus in order to reduce anxiety the stimulus triggers. Takes place across small number of long therapy sessions.

How does it work? Without avoidance behaviour the phobia isn't maintained. This process is called extinction in classical conditionin g terms, the conditioned response is extinguished when the conditioned stimulus (e.g. dog) is encountered without the unconditioned stimulus (e.g. being bitten). The conditioned stimulus will no longer produce the conditioned response (fear).

Ethical safeguards - unpleasant experience so it is important that patient gives fully informed consent to the procedure and that they are fully prepared for the process.

It is effective - Gilroy et al. followed up 42 patients who had been treated for arachnaphobia by systematic desensitisation, and a control group was treated by relaxation without exposure. The SD group was less fearful than the control group.

It is suitable for a diverse range of patients - more suitable than flooding of cognitive therapies for some people, e.g. those with learning difficulties. Learning difficulties can make it hard to understand what is happening or to reflect on what you're thinking.

Acceptable to patients - patients prefer it; it does not cause the same degree of trauma so there are low refusal rates and low attrition rates.

Cost-effective - studies such as Ougrin comparing flooding to cognitive therapies show that flooding is highly effective and quicker than alternatives; making treatments cheaper.

Less effective for some types of phobia - less effective for more complex phobas like social phobias; may be because they have cognitive aspects, so suferers may benefit more from cognitive therapies.

Treatment is traumatic for patients - patients often unwilling to see it through to the end; time and money can be wasted.

Becks cognitive theory - Aaron Beck used this approach to explain why some people are more vulnerable to depression than others.

Faulty information processing -depressed people focus on the negative aspects and ignore the positives, they also tend to blow small problems out of proportion and think in 'black and white' terms.

Negative self-schemas -a schema is a package of ideas and information developed through experiences. They act as a mental framework, people with a negative self-schema will see all information about themselves in a negative way.

The negative triad - there are 3 elements of this. 1) Negative view of the world, e.g. the world is a cold hard place. 2) negative view of the future, e.g. there isn't much chance that the economy will get better. 3) negative view of the self, e.g. I am a failure.

Albert Ellis - proposed that good mental health is the result of rational thinking, so people with depression have irrational thinking.

A; Activating agent - a negative life event that triggers a response.

B; Beliefs - beliefs that lead to overreacting to the activating event.

C; Consequences - depression results when we overreact to negative life events.

The activating agents triggers an irrational belief which causes an emotional response (depression).

Good supporting evidence - Grazioli and Terry assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. Women who were more cognitively vulnerable were most likely to suffer from post-natal depression.

It has a practical application in CBT -it forms the basis of a Cognitive Behaviour Therapy, all cognitive aspects of depresssion can be identified and challenged, so therapists can challenge them and encourage the patient to test whether they are true. This will help towards successful therapy.

It doesn't explain all aspects of depression -deperssion is complex, and some suffers are deeply angry, and Beck's theory can't easily explain this extreme emotion. It also can't explain cases where the depressed suffer Cotard syndrome (think they're zombies).

A partial explanation - some cases of depession follow activating events (reactive depression), but some cases of depression arise without an obvious case.

It has practical application in CBT - it has lead to successful therapy, and it's supported by research evidence (Lipsky et al). This suggests that irrational beliefs do have a role in the depression.

It doesn't explain all aspects of depression - it doesn't easily explain the anger associated with depression or the fact that some patients sufffer hallucinations and delusions.

Cognitive Behaviour Therapy (CBT) - based on both cognitive and behavioural techniques; will challenge negative thoughts and use behavioural activation.

Beck's cognitive therapy - identify the negative triad and challenge these thoughts, and help patients test the reality of their negative beliefs by encouraging them to record when they enjoy an event or when someone is happy to see them.

Ellis's rational emotive behaviour therapy (REBT) - extends ABC model to ABCDE, D stands for dispute and E for effect. The idea is to identify and dispute (challenge) irrational thoughts, e.g. empirical argument involves disputing whether there is evidence to support the irrational beliefs, and the logical argument involves disputing whether the negative thought logically fololows from the facts.

Behavioural activation - encourage patients to be more active and engage in enjoyable events to provide more evidence for irrational nature of beliefs.

It is effective - March et al. compared effects of CBT with antidepressant drugs and a combination of the two; the effects on 327 adolescents with depression were compared. 81% of CBT group and 81% of antidepressant group, and 86% who used both were significantly improved, so CBT is just as good as medication and helpful alongside medication.

May not work for most severe cases - patients may not be able to motivate themselves to engage in the hard cognitive work.

Sucess may be due to the therapist-patient relationship - Rosenzweig suggested difference between different methods of psychotherapy may be quite small. They all share the essential ingredient of the relationship between a patient and a therapist.

Genetic explanations - genes make up chromosomes and consist of DNA which code physical and psychological features of an organism. Genes are inherited - they are involved in individual vulnerability to OCD. Lewis found that 37% of his OCD patients had parents with OCD, and 21% had siblings with OCD, suggesting that OCD runs in families (more likely to give a genetic vulnerability than certainty of OCD). OCD is thought to be polygenic (several genes involved in causing OCD) - Taylor found evidence of up to 230 different genes being involved.

Diathesis-stress model - suggests that people gain a vulnerability to OCD through genes, but an environmental stressor is required to trigger the condition.

Candidate genes - these create the vulnerability. Some of these genes are involved in serotonin system, and OCD can be caused by low-levels of neurotransmitter serotonin in the brain (affects the trasmission of mood-related information across the synapse).

Neural explanations - physical and psychological characteristics are determined by behaviour of nervous system, in particular the brain and individual neurons.

Role of serotonin -the neurotransmitter serotonin helps regulate mood. If serotonin levels are low then normal transmission doesn't take place, affecting mood and other mental processes. This can explain some cases of OCD.

Decision-making systems -impaired decision-making is the cause of some cases of OCD (e.g. hoarding), and can be explained by abnormal functioning of the frontal lobes of the brain (responsible for logical thinking and making decisions). Also, the left parahippocampal gyrus is associated with processing unpleasant emotions, and there is some evidence that it functions abnormally in OCD.

Good supporting evidence - Nestadt et al. reviewed twin studies and found that 68% of monosygotic twins shared OCD, opposed to 31% of dizygotic twins - suggesting a genetic influence.

Too many candidate genes -the number of genes involved provided very little predictive value, as each genetic variation only increases the risk of OCD by a fraction.

Environmental risk factors - environmental factors also play a role; Cromer et al. found that over half of OCD patients in their sample had a traumatic event in their past, and OCD was more severe with those with more than one trauma. Supports idea of diathesis-stress model.

Some supporting evidence - some antidepressants work purely on the serotonin system, increasing the levels of it. These drugs are effective in reducing systems of OCD.

Not clear which neural mechanisms are involved - Cavedini et al. study shows that these neural systems are the same systems that function abnormally in OCD. However, other research has identified that other brain systems may be involved sometimes.

Shouldn't assume that neural mechanisms cause OCD -evidence shows that various neurotransmitters and structures of the brain do not function normally in OCD patients. However, it may not be the cause of the OCD, the OCD may cause these things to happen.

Drug therapy - aims to increase/decrease levels of neurotransmitters in the brain, or to increase/decrease their activity.

SSRI's -(selective serotonin reuptake inhibitor). Serotonin is released by the presynaptic neurons and travels across a synapse. It then conveys the signal to a postsynaptic neuron, and is then reabsorbed and reused by the presynaptic neuron. By preventing its reabsorption and breakdown it effectively increases its levels in the synapse and continues to stimulate the post-synaptic neuron. Compensating for what's wrong in the serotonin system for OCD suffers.

Combining SSRI's with other treatments - often combined with CBT, the drugs decrease emotional symptoms and allow patients to engage more effectively with CBT.

Alternatives to SSRI's - tricylics or SNRI's may be used if SSRI's arent effective.

Effective at tackling OCD symptoms - Soomoro et al. reviewed studies comparing SSRI's to placebos, all studies showed better results for SSRI's than the placebos -  symptoms declined around 70% for SSRI's. Effectiveness is greatest when combined with psychological treatment (CBT).

Cost-effective and non-disruptive - cheap compared to psychological treatments, and doesn't require the hard work of psychologcial therapy.

Drugs can have side-effects - a minority will get no benefit, and some will have side-effects such as indigestion, blurred vision and loss of sex-drive. For clomipramine the side-effects include erection problems, tremors and weight gain.