Psychopathology

Deviation from social norms

• Social norms - expected patterns of behaviour accepted by the majority of a society
• Deviating from social norms mean the person is considered abnormal

AO3 - Limitations

• Different cultures have different norms, so the definition is culturally relative
• Social change means social norms change over time, so behaviour classed as abnormal now may be a norm in the future
• Context is needed to decide if a person's behaviour is abnormal. For example, a person eating cereal in the morning would not be abnormal, but a person eating it at night is considered abnormal.

Failure to function adequately

• Day-to-day inability to cope
• Feelings of worry or distress caused by, for example, a phobia, lead to the person being unable to complete day-to-day tasks, which is considered abnormal.

AO3 - Limitations

• Cultural relativism - different cultures have different standard ways of living, so the definition lacks reliability
• Adaptive behaviour - sometimes, dysfunctional behaviour can be adaptive and functional for the individual

Deviation from ideal mental health

• Jahoda (1958) claims mental illness, like physical illness, can be diagnosed by pointing out the absences of the ideal mental health. She came up with six categories making up 'normal' mental health. If any one of these is missing, the person is considered abnormal:
  • Self-attitudes (high self-esteem)
  • Personal growth (being the best you can be)
  • Integration (ability to cope with stressful situations)
  • Autonomy (independence)
  • Accurate perception of reality (seeing the world as others see it)
  • Environmental mastery (ability to problem-solve and adjust to new situations)

AO3 - Limitations

• The criteria are hard for anyone to achieve, meaning the majority of people would be classed as abnormal
• Mental and physical health are not the same and cannot be diagnosed as such
• Categories are culturally relative, e.g. personal growth only relevant to individualistic cultures

Statistical infrequency

• Shows abnormality on a normal distribution curve
• People at either end of the curve, where the frequency is low, are considered abnormal

AO3 - Limitatons

• Not all infrequent behaviour is abnormal. High IQ is rare but considered desirable rather than abormal.
• Cultural relativism - statistically rare behaviour in one culture may be statistically common in another
• Not all abnormal behaviours are infrequent. Depression, while being an abnormal behaviour, is statistically common, as 10% of people will have chronic depression at some point.

Emotional Characteristics

• Anxiety - an unpleasant state of high arousal; inability to relax; can be long-term as the person is constantly fearful of encountering the phobic stimulus
• Fear - experienced when person comes into contact with phobic stimulus. Emotional response appears unreasonable and disproportionate, e.g. panic attacks

Behavioural Characteristics

• Panic (screaming, crying, running away, freezing, fainting, tantrums)
• Avoidance (avoiding situations where phobic stimulus may be encountered)
• Endurance (suffering anxiously until situaton is over)

Cognitive Characteristics

• Selective attention - can't focus on anything else
• Irrational beliefs - overstate potential danger of phobic stimulus
• Cognitive distortion - distorted perception of phobic stimulus (person may know it is unreasonable)

Emotional Characteristics

• Low mood, including feelings of wothlessness, lethargy and emptiness
• Anger towards others and themselves, often expressed through aggressive behaviour
• Low self-esteem; can lead to self-loathing

Behavioural Characteristics

• Reduced activity levels due to reduced energy levels
• Can cause insomnia or hyperinsomnia
• Change in appetite can lead to weight gain or loss
• Aggression, can lead to self-harm and suicide attempts

Cognitive Characteristics

• Poor concentration, leading to difficulty in focusing on work
• More likely to have absolutist thinking
• Unable to see the positives of a situation, focusing on the negatives

Emotional Characteristics

• Fear and anxiety due to the urge to repeat compulsive behaviours
• Can lead to depression, as they are unable to enjoy many activities due to their obsessions
• Irrational guilt or disgust, either with themselves or an external object, e.g. dirt)

Behavioural Characteristics

• Compulsions - repeated behaviours, e.g. hand washing
• Carrying out compulsions reduces anxiety for 90% of OCD sufferers
• Avoidance can help reduce anxiety linked to an obsession
• Social impairment due to excessive anxiety

Cognitive Characteristics

• Obsessive element of OCD - recurrent thoughts, often worst-case scenarios
• Doubtful thoughts also present
• Many sufferers understand the irrationality of their thoughts but are unable to control them

Two Process Model

• Stage 1 - Acquisition
  • Phobias can occur naturally through classical conditioning, or through social learning
• Stage 2 - Maintenance
  • Avoidance responses act as negative reinforcer as it reduces the fear response, leading to the person repeating that behaviour (operant conditioning)

Research - Little Albert

• Child known as Little Albert was shown a rat to prove he had no existing fear. While he played with the rat, a loud noise was made to scare him. This was repeated several times. After this, he would cry and crawl away from any white, fluffy animal. Concluded that emotional responses are acquired as a direct result of environmental factors.
  • Evaluation - Findings cannot be verified as it would be unethical to repeat the study. Ethical concerns present - conducted without mother's consent, child was psychologically harmed

Strengths

• Supported by Little Albert study (see previous card)
• Led to effective counter-conditioning treatments such as flooding and systematic desensitisation

Limitations

• Contradictory explanation - evolutionary theory. Suggests some phobias have survival value. Explains why phobias of snakes are relatively common but few sufferers have ever been harmed by a snake.
• Contradictory explanation - cognitive theory. Suggests phobias have maladaptive behaviours. They have attentional bias (focus more on anxiety-generating things).

Systematic Desensitisation

• Uses the concept of classical conditioning to counter-condition the phobia
• Assumes fear and relaxation are opposites and cannot be experienced at the same time
• Staged approach:
  • 1. Phobia proken down into 'anxiety hierarchy', from most feared to least feared situaton
  • 2. Therapist teaches relaxation techniques
  • 3. Client exposed to each stage and encouraged to relax at every step
  • 4. Phobic stimulus becomes associated with relaxation rather than fear

Evaluation

• Strength - more ethical than flooding, as the focus is on relaxation
• Limitation - can only work on simple phobias and not complex phobias
• Limitation - can only work for those willing to confront phobic stimulus
• Limitation - expensive and time-consuming, as it takes many sessions of therapy

Flooding

• Involves direct contact with most feared object or stimulus
• Anxiety levels peak, so it must reduce eventually due to exhaustion
• Therapist must ensure patient remains in the situation until fear response subsides, or the fear will become worse because of operant conditioning

Evaluation

• Limitation - lower completion rate than systematic desensitisation, as it is far less pleasant
• Limitation - ethical concerns, as patient is exposed to extreme psychological harm
• Limitation - unsuitable for some people (children, older people, and those with heart conditions)

Beck's Negative Triad

• Negative self-schemas are developed during childhood
• These lead to cognitive biases (distortions and misinterpretations of information) such as overgeneralisations and catastophising
• Cognitive biases maintain the negative triad, which contains three parts:
  • Negative view of the self
  • Negative view of the future
  • Negative view of the world

Evaluation

• + Practical application - forms the basis of CBT which challenges all cognitive aspects of depression
• + Good supporting evidence - lots of research also suggests that depression is associated with his three components of cognitive vulnerability
• - Some critics suggest some depressed people have an accurate view of events, they just focus on the negatives. They will not show the negative biases Beck says all people with depression have.

Ellis' ABC Model

• Suggets that good mental health is the result of rational thinking
• There are common irrational beliefs that underlie depression, so sufferers have based their lives on these beliefs
• Action is affected by an individual's Beliefs which results in a Consequence
• activating event -> irrational thoughts -> undesirable emotions -> undesirable behaviour

Evaluation

+ Practical application in CBT, which challenges irrational beliefs

- Not all depression is due to an activating event (some is, known as reactive depression)

- Does not explain why some sufferers have hallucinations or delusions

• Cognitive Behavioural Therapy (CBT) is a way of talking about:
  • how you think about yourself, other people and the world
  • how what you do affects your thoughts and feelings
• The cognitive element deals with thinking, e.g. challenging negative thoughts
• The behavioural element involves techniques such as behavioural activation (encouraging patients to engage in activities they are avoiding

• Beck's Cognitive Therapy follows these steps:
  • Client asked about how they percieve themselves, the world and the future
  • Theraist uses reality testing to see if their views are really the case
  • Client made aware of negative views, allowing irrational views to be replaced with more rational and optimistic beliefs
  • Client may get homework to challenge/test their negative thoughts themselves

• Ellis' Rational Emotive Behavioural Therapy (REBT) extends the ABC model to include Dispute and Effect. Disputes patients' irrational beliefs to replace them with effective beliefs/attitudes.
  • Logical dispute - questioning the logic of their thoughts
  • Empirical dispute - seeking evidence for their thoughts

Strengths:

• Supporting research from March et al. They looked at the effectiveness of CBT and antidepressants and found that 81% of both the CBT and antidepressant groups improved significantly
  • 86% of the group that received both CBT and antidepressants improved, suggesting a combination of both may be most effective
• Client is actively involved and learns to help themselves in new situations

Limitations:

• Requires motivation, so may not be suitable for people with severe depression
• Overemphasis on the role of cognition while ignoring other factors such as their living situation
• Success may be due to the relationship between client and therapist - may be the opportunity to talk to someone who will listen that is effective, as research has shown there is little difference between CBT and other forms of psychotherapy.

Genetic explanation

• OCD seems to be a polygenic condition - Taylor suggests up to 230 genes are involved
• Two genes linked to OCD are the COMT gene and the SERT gene
• COMT is associated with the production of catechol-O-methyltransferate, which regulates the neurotransmitter dopamine
  • most common variation in OCD patients results in higher levels of dopamine
• SERT (serotonin transporter) appears to be mutated in OCD patients
  • mutation causes increase in transporter proteins at neuron membrane, leading to an increase in reuptake of serotonin into neuron
  • this decreases the level of serotonin in the synapse (also associated with depression

Evaluation

• Carey and Gottesman - concordance rate for obsessive symptoms for identical twins was 87% compared to 47% in fraternal twins
• Concordance rates are not 100% so genes are not the only factor, they only create vulnerability - genetic explanation is reductionist

Neural explanation

• Abnormal levels of some neurotransmitters mean some brain circuits may be abnormal
• Basal ganglia - responsible for innate psychomotor functions
  • hypersensitivity of basal ganglia leads to repetitive motor behaviours as seen in OCD
• Thalamus - functions include safety behaviours like cleaning
  • overactive thalamus leads to increased motivation to clean and check for safety
• Orbifrontal cortex - involved in decision making and worry about behaviour
  • overactive OFC leads to increased anxiety and increased planning to avoid anxiety

Evaluation

• Technological advancements have allowed researchers to confirm that OCD sufferers to seem to have excessive activity in the OFC
• While an abnormal basal ganglia may explain compulsions it cannot explain obsessive thoughts
• Inconsistencies in research - no one brain structure is the cause of OCD, and neural changes may even be a result and not a cause of OCD

Drug therapy

• Antidepressants (such as SSRIs, or selective serotonin reuptake inhibitors) increase levels of serotonin recieved by the post-synaptic neuron by preventing it from being reabsorbed into the pre-synaptic neuron.
• Anti-anxiety drugs (such as Benzodiazepines) work by enhancing the action of the neurotranmitter GABA (gammaaminobutyric acid), which tells neurons in the brain to 'stop firing', thus having a quietening effect on the brain. This reduces anxiety which is the cause of obsessive thoughts.

Evaluation

• Soomro et al. - SSRIs significantly better than placebos at reducing OCD symptoms in 17 different clinical trials
• Cheaper than psychological treatments like CBT.
• Most drugs have unpleasant side effects, such as weight gain and sleepiness
• Targets symptoms rather than cause. Once the patient stops taking the drug they are prone ot relapse. Psychological treatments such as CBT may be a more effective long-term solution.