Psychopathology

• Defines abnormality in terms of how common something is or how often a behaviour is observed - stats such as mean, median and mode applied to behaviour
• Anything uncommon or not usually seen deemed abnormal - standard deviation used to determine this
• Example topics include shoe size and IQ scores
• Real world application e.g., diagnosis of intellectual disability
• Objective model - based on stats
• Cut off point between normal and abnormal subjectively determined
• Model doesn't distinguish between desirable and undesirable e.g., high IQ is abnormal but desirable

• Anyone who does not follow unwritten rules/norms of society seen as abnormal
• Anti-social personality disorder classified by DSM as having absence of prosocial internal standards - don't conform to norms
• Distinguished between desirable and undesirable
• Can help people to live together in society
• Can lead to abuse of human rights e.g., implies anyone not conforming is mentally ill so abuses people's right to be different/unique
• Social norms vary over time and culture e.g., old norms no longer relevant
• Norms for one culture e.g., hearing voices in African culture differ from another

• Inability to cope with everyday demands of life e.g., can't keep job/relationship
• Causes distress to individual due to inability to cope
• Causes distress to others e.g., schizophrenics unaware of behaviour but others see them and worry

Rosenhan and Seligman

• Person no longer conforms to standard, interpersonal rules e.g., eye contact
• Behaviour becomes irrational and dangerous, and person experiences distress
• Depression manifests as FFA e.g., lack motivation to get out of bed
• Some disorders e.g., Intellectual Disability Disorder need person to be perceived as failing to function adequately for a diagnosis

• Takes subjective view of patient into account
• Abnormality depends on person making judgement
• Some people don't recognise they are failing to function so judgement based on other people's subjective view - although can be measured against behaviour checklist
• Dysfunctional behaviours may be seen as functional e.g., gaining attention due to symptoms

• Marie Jahoda said mental health should be treated the same as physical health - looking for absences in health 
• 6 criteria for 'good' mental health allowing people to behave competently 
• SELF-ATTITUDES - high self-esteem and strong sense of identity
• SELF ACTUALISATION - reaching potential
• INTEGRATION - cope with stressful situations
• AUTONOMY - being independent and making personal decisions
• ACCURATE PERCEPTION OF REALITY - not unrealistic
• MASTERY OF ENVIRONMENT - ability to successfully work, have relationships and adjust to new situations

• Positive approach - looks at positive behaviours rather than negative
• Criteria unrealistic - very few attain all characteristics so lots of 'abnormal' people + some hard to measure
• States mental and physical health are the same but physical health has physical causes but mental health doesn't always - questions validity of diagnosis of mental health in same way as physical 

• Cultural norms and values are culture-specific and one is not superior to any other

Statistical Infrequency

• What is statistically common in one culture not the same as another e.g., hearing voices of deceased

Deviation From Social Norms

• Norms vary between cultures so what is deemed as acceptable in one culture not the same as another e.g., some cultures tend to stand closer together when talking (personal space)

Failure To Function Adequately

• Ideas of what is considered as adequate functioning differ between cultures e.g., lower-class and non-white cultures seen as failing to function adequately if lifestyle differs from dominant cultures

Deviation From Social Norms

• Jahoda based criteria on Western cultures, so would lead to more abnormality in non-Western cultures e.g., self-actualisation doesn't apply to collectivist cultures (they want greater good for community)

• Anxiety disorder, which interferes with daily living
• Instance of irrational fear that produces conscious avoidance of feared object/situation
• 3 types of phobia according to DSM
• Specific phobias - sufferers anxious in presence of particular stimulus
• Social phobias - phobia of public situations e.g., public speaking 
• Agoraphobia - phobias of being outside or in public space 

Emotional Characteristics

• High anxiety when in presence of stimulus - unpleasant state of high arousal
• May occur when imagining/anticipating phobia
• Emotions unreasonable and disproportionate

Behavioural Characteristics

• Panic - may panic in response e.g., freeze, cry and scream
• Avoidance - person goes out of way to avoid it - may interfere with life e.g., relationships
• Endurance - Stay in presence of stimulus and experience high anxiety levels (if cannot avoid)

Cognitive Characteristics

• Selective Attention - person unable to not look at stimulus when in its presence 
• Irrational Beliefs - individual holds irrational beliefs about phobia
• Individual has cognitive distortions + usually realise their thoughts are irrational but unlikely to be resistant to rational arguments 

• Little Albert acquired phobia at 9 months old since he associated a white rat with the unconditioned stimulus of a loud bang - making it conditioned stimulus

White Rat (NS) ---> No Response

Loud Noise (UCS) ---> Fear Response (UCR)

Loud Noise and White Rat (UCS + NS) ---> Fear Response (UCR)

White Rat (CS) ---> Fear Response (CR)

• Classical conditioning does not explain how phobias are maintained
• Negative reinforcement - people avoid phobias, taking away the negative feeling (this avoidance makes it more likely to happen again) - this negatively reinforces the phobia so maintains it

Two Process Model

• Mowrer (1960) developed model to describe behavioural approach to explaining phobias
• Phobias acquired by classical conditioning (association) and maintained by operant (reinforcement)

• Phobias may be acquired by modelling behaviour of others
• E.g., seeing parent respond to spider with fear may cause child to acquire same fear
• Especially likely when someone is rewarded for fear e.g., getting attention from others

• Real life application - explains why exposure is necessary to prevent reinforcement - behavioural therapies developed based on two process model
• Empirical research from Watson and Rayner - Little Albert
• Support for social learning theory - Bandura and Rosenhan (1966) got model to act in pain when a buzzer sounded + later, participant acquired fear response to buzzer
• Patients do sometimes have event/trigger for phobia, but often can't be recalled
• Not all people who experience traumatic event have a phobia - could be explained by diathesis stress model
• Explanation reductionist - oversimplifies and ignores cognitive factors e.g., irrational thinking
• Alternative explanations e.g., biological preparedness - Seligman (1970) suggests people have biological preparedness to develop certain phobias rather than others as they were adaptive in evolutionary past

• Supporting research
• Appropriate treatment for diverse range of patients
• Relatively fast and requires little effort from patient (compared to CBT)
• May be good for children/people with learning disabilitites - doesn't require much complex thinking as CBT does 
• More appropriate than flooding as less traumatic - low refusal and dropout 
• Deals with symptoms not cause
• Lead to symptom substitution - symptoms resurface but sometimes in another form

• Exposing patient to phobia without gradual build-up
• Endure one long session where they are exposed to phobia at its worst whilst practising relaxation techniques
• Sessions continue until patient is relaxed in presence of phobia
• Works by preventing reinforcement (can't avoid stimulus so not negatively reinforced)
• Fear eventually subsides and replaced with new response e.g., relaxation

• Less time consuming as only 1 session - cost effective
• Choy et al (2007) found it was more effective when endured
• Individual differences in how effective treatment is (some not suited to trauma)
• Patients give consent but may drop-out - time and money wasted
• Treats symptoms not cause
• Lead to symptom substitution

• Classed as mood disorder (changes is mood)
• DSM states 5 symptoms must be present for diagnosis including loss of interest in normal activities +
• Depressed mood most of day, nearly every day
• Diminished interest in pleasure in almost all activities most of the day, every day
• Significant weight loss/gain (unintentional)
• Slowing down of thought and reduction of physical movement noticed by others
• Fatigue or loss of energy every day
• Feelings of worthlessness or excessive inappropriate guilt almost every day
• Dimished ability to think and concentrate, or indecisiveness almost every day 

Behavioural Characteristics

• May have higher activity levels e.g., psychometric agitation or lower levels e.g., losing motivation and withdrawing from events and work
• Insomnia (lack of sleep) or hypersomnia (extreme fatigue)
• Weight loss/gain due to appetite changing

Emotional Characteristics

• Lowered mood and feeling low or empty 
• Anger directed at themselves or others
• Low self-esteem - may dislike themselves and self-loath

Cognitive Characteristics 

• Poor concentration and difficulties with decisions and staying on task
• Negative thoughts - negative self concept + expect worst = self-fulfilling prophecy

• Based on fact that depression caused by the way we think about a problem rather than problem itself
• Claimed good mental health result of rational thinking
• Musturbatory thinking - irrational belief that ideas/assumptions MUST be true in order to be happy - leads to depression when person becomes disappointed e.g., I MUST do well or I am not important
• A - Activating event - something happens in environment around you
• B - Beliefs - hold a belief about situation which may be irrational or rational
• C - Consequence - there will be emotional/behavioural consequence as a result of your belief
• A = friend passes you in corridor and doesn't say hello even though you do
• B = Rational - they are busy and didn't see you OR Irrational - they never want to talk to you again because they don't like you 
• C = Rational - you will talk to them later OR Irrational - delete their number because they hate you - THIS LEADS TO DEPRESSION

Negative Schemas 

• Gained in childhood + apparent In people with depression e.g., caused by rejection or criticism by authority figures - become pessimistic and view world negatively
  
• Negative schemas become activated when in a new situation

Cognitive Biases/ Faulty Thought Processing

• Negative schemas lead to cognitive biases - distorting and misinterpreting info
• Overgeneralisation - sweeping conclusions made from single event e.g., failing one test leads to conclusion of being a worthless failure
• Catastrophising - exaggerating minor setbacks and believing it is a disaster e.g., failing one test so believing you won't go to uni and get a good job

Negative Triad

• Cognitive biases and schemas maintain negative triad
• Negative view of world, future and self

• Practical application - lead to CBT development 
• Research support - Krantz (1976) found depressed patients made more errors in logic when interpreting written material
• Suggetsed that irrational beliefs may be realistic - Alloy and Abrahmson (1976) said people with depression were more accurate in estimates of likelihood of disaster - 'sadder but wiser' effect
• Hard to determine cause and effect - do irrational thoughts cause depression or are faulty thought patterns an effect?
• Blames individual - client responsible for disorder and other factors e.g., environment overlooked

• Combines cognitive and behavioural therapies by identifying irrational beliefs and testing them through experiments and homework
• Begins with initial assessment to identify faulty thought processes, and then goals are set and plan of action worked out

Beck's Cognitive Therapy

• Based on negative triad
• Identify negative thoughts in relation to themself, future and world then discussed and challenged - set homework to test validity of negative thoughts

Ellis' Rational Emotional Behavioural Therapy (REBT)

• Extends model - ABC(DEF) - challenge thoughts and replace them rationally
• D - Disrupting irrational thoughts
• E - Effects of disputations
• F - new Feelings that are produced

Different types of argument used to dispute irrational beliefs:

• Logical disputing - disputing whether thoughts flow logically from facts - does it make sense?
• Empirical disputing - disputing that there is any evidence to support belief
• Pragmatic disputing - emphasises lack of usefulness of belief - how does it help me?

Behavioural Activation

• People encouraged to increase activity levels and anticipate any cognitive obstacles preventing them doing so during therapy
• Encouraged to engage in more activities they enjoy to act as reward and alleviate depression

Homework

• Aids progression between sessions
• E.g., if someone feels no one likes them, they may be asked to record how many times someone smiles at them in a day
• Allows patient to challenge belief and prove them wrong

• Research support for CBT - Ellis (1957) found 90% success over average of 27 sessions and March et al (2007) found CBT just as effective as medication in study of 327 adolescents (81% both CBT and medication, and 86% combination)
• Requires motivation to be effective - may see high dropout rates as patients need to be very engaged 
• Individual differences - not appropriate when they lack motivation or are resistant to change 
• Overemphasis on cognition - ignores other influences such as poverty or abuse that need to be solved to treat disorder  

• Disorder categorised by obsessions and compulsions, causing repetitive intrusive thoughts and anxiety avoiding behaviours - 2% population
• Obsessions - recurring thoughts, images etc.
• Compulsions - repetitive behaviours e.g., hand washing
• Trichotillomania - compulsive hair pulling
• Hoarding disorder - compulsive collecting of items + being unable to part with them
• Excoriation disorder - compulsive skin picking

OCD Cycle

• Explains how obsessions and compulsions are linked
• Obsessions make person feel anxious, causing compulsive behaviour for temporary relief
• Obsessions --> Anxiety --> Compulsions -->Relief    (and repeat in cycle)

Obsessions, or compulsions, or both must be present 

• Obsessions - recurrent and persistent thoughts/urges considered as intrusive that cause anxiety and distress. Individual attempts to ignore and suppress them with another thought or action (compulsion)
• Compulsions - repetitive behaviours or mental acts e.g., praying, counting etc. an individual feels they need to perform in order to suppress an obsession, or according to rules that must be followed rigidly. The action aims to end any feeling of distress, or stop a dreaded event, although the action is unrelated, and is clearly excessive
• Obsessions or compulsions are time-consuming or cause clinically significant distress or impairment of functioning
• Obsessive-compulsive symptoms not an effect of any drugs or another medical condition

Biological Characteristics

• Compulsions to reduce anxiety and distress (not usually connected in realistic way) - behaviours or mental acts
• Avoidance - may avoid situations that trigger their anxiety e.g., avoid contact with germs

Emotional Characteristics

• Anxiety and distress
• Disgust is common in those with germ obsession
• Symptoms of depression alongside OCD - feel ashamed of actions

Cognitive Characteristics

• Obsessive thoughts - recurring thoughts/images e.g., germs or locking door
• Intrusive thoughts/impulses deemed as inappropriate

Predisposition to OCD inherited (2 genes related)

COMT Gene

• Production of enzyme COMT that regulated dopamine (associated with OCD symptoms)
• One gene variation common in OCD patients - lower levels of COMT so more dopamine

SERT Gene (Serotonin Transporter Gene)

• Linked to transportation of serotonin
• Variation leads to lower serotonin levels, linked to symptoms of OCD + depression

Nesdadt et al (2000) + (2010)

• 80 OCD patients and 343 near relatives compared with control group (no mental illness+relatives) found strong link with near family - 5x more risk than average if first degree relative had OCD
• Reviewed previous twin studies and OCD  - 68% identical twins and 31% non identical had OCD

Neurotransmitters

• Low serotonin - regulates mood and low levels = mood disorders
• High dopamine - compulsive behaviours
• Antidepressants effective treatment - increase serotonin in synapse

Pigott et al (1992) - drugs effective in reducing OCD showing link between OCD and serotonin

Normal Response

• Orbitofrontal cortex (OFC) detects worry and sends message to thalamus
• Caudate nucleus intercepts message and suppresses it to reduce strength
• Thalamus picks up message and sends one back to OFC
• OFC interprets message and responds with appropriate behaviour

Abnormal Brain Circuits

• Caudate nucleus ( in basal ganglia) damaged so messages aren't suppressed - thalamus is alerted and increases compulsive behaviour and anxiety

Neurotransmitters

• Serotinin has key role in OFC and caudate nuclei - low levels lead to malfucntion
• Dopamine main neurotransmitter in basal ganglia - high levels = overactivity

• PET scans show heightened use of OFC in OCD patients
• Suggested link between genes and anatomical links - OCD patients and close relatives have decreased grey matter in brain (OFC) - Menzies et al (2007) said anatomical differences inherited

• Concordance rates not 100% so other factors may be involved - Cromer (2007) found over half of OCD patients experienced traumatic experience in past
• Reductionist approach - cognition and learning not considered - suggested that two process model may also explain OCD
• Difficulty determining cause and effect

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Prevent reabsorption or breakdown of serotonin
• Higher levels of serotonin in synaptic cleft so postsynaptic neuron stimulated
• Serotonin released into synapse, and targets receptor sites on post-synaptic neuron
• Serotonin left in synapse reabsorbed by presynaptic neuron - SSRIs block this so more in synaptic cleft to stimulate post-synaptic neuron 

Tricyclic Antidepressants

• Block transporter mechanisms that reabsorb serotonin and noradrenaline - more in synapse
• More side effects 

Anti-Anxiety Drugs

• Benzodiazepines (BZs) alleviate anxiety by enhancing NT GABA (slows CNS by preventing neurons firing)

• Drugs require little motivation compared to CBT - may have lower drop-out rate
• Generally cheaper and less disruptive to everyday life
• Evidence shows effectiveness - Soomro et al (2008) found SSRIs more effective than placebos in review of 17 trials
• Treat symptoms and not cause
• Side effects - SSRIs = indigestion, blurred vision, lack of sex drive and BZs are addictive so only short term treatment