psychopathology

-a normal distribution curve is used to measure what proportions of ppl share characteristics.
-those who fall outside the 'normal distribution' (approx. 5% of population) will be perceived as 'abnormal'.
-2 standard deviation points away from the mean = abnormal. 

STRENGTH
- high objectivity: this method uses unbiased statistical data to calculate who's abnormal, which avoids subjectivity.
WEAKNESSES
-some disorders arent statistically rare: diagnostic manuals identify some disorders which dont fit in with statistical infrequency e.g. depression & anxiety are common mental illnesses, thus aren't statistically rare.
-fails to count desirable abnormality: some characteristics such as high IQ are desirable but still statistically rare, which means this method is unhelpful for identifying undesirable behaviours resulting from mental disorders which need help.

-culturally relative.
-labels abnormality as those who deviate from social norms (social deviants).
-how far the norm is deviated from & how much importance society places on the norm is important here.

STRENGTH
-accounts for age: for example, a child screaming in a shop is seen as acceptable, but unacceptable for an adult, so it considers important factors.
WEAKNESSES
-norms change w/ time: norms constantly change according to social attitudes, so its hard to define abnormality w/ norms which are forever changing.
-cultural variation: no universal agreement over norms, so abnormality may be defined differently according to the culture.

-inability to cope w/ everyday demands or distress leading to inability to cope e.g. cant experience normal emotions or behaviours.
-features of dysunction:
1)maladaptive behaviour = stops you attaining life goals, both occupationally & socially.
2)irrationality = displaying behaviour which cant be rationally explained.
3)observer discomfort = behaviour which causes discomfort to others.
4)unpredictability = unexpected behaviours.

STRENGTH
-focusses on individual: no comparing them to societies expectations to define abnormality& acknowledges how their thinking/feeling.
WEAKNESSES
-some behaviours cant be explained: many behaviours are abnormal but arent characterised by inability to function e.g. Harold Shipman was very socially competent but was a prolific serial killer.
normal abnormality: many of us will go through periods of failing to function adequately as a perfectly healthy response e.g. grieving.

-focusses on the absence of ideal mental health
-Jahoda identified criteria of IMH:
1)positive attitude towards self e.g. high self esteem.
2)resistance to stress e.g. effective coping strategies.
3)accurate perception of reality e.g. objective/realistic view of world.
4)independent (autonomy) e.g. self-reliance & personal decisions.
5)self-actualisation e.g. self-growth & focussing on future.
6)environmental mastery e.g. ability to adapt to changing life circumstances/meet the demands of any situation.

STRENGTH
-comprehensive criteria: unlike other definitions, it considers person as a whole & looks at multitude of factors which could be affecting their mental health.
WEAKNESSES
-demanding criteria: most of us wouldnt meet the criteria e.g. very few experience self-actualisation, limiting its effectiveness in defining those who have mental health problems.
-ethnocentric criteria: focusses on Western values of self-actualisation & autonomy, whereas collectivist cultures encourage inter-dependence & doing things for others.

SUBTYPES
-specific phobias = fear of specific thing e.g. spiders
-social phobias = overly anxious in social situations e.g. crowds
-agoraphobia = fear of leaving home/safe place, can be response to avoidant behaviours.
CHARACTERISTICS
-behavioural: panic + avoidance
-emotional: fear + anxiety
-cognitive: selective attention (fixation) + irrational beliefs

-behaviours are acquired through classical conditioning:
LITTLE ALBERT: Watson & Rayner
-behaviours are maintained through operant conditioning:
SKINNERS RAT BOX
-avoidance of fear object/situation acts as negative reinforcement, causing reduced anxiety, thus avoidance behaviour is strengthened & phobia is maintained.

EVALUATION:
(R) supporting evidence: Little Albert, Sue et al - found most recall specific incident when phobia was created when their phobia appeared (fails to mention maintenance, therefore incomplete).
(I) other factors: Dinardo - similar amount of ppl w/ dog phobias & traumatic experience as to those w/ dog phobia, but NO experience.
(A) treatments: systematic desensitisation & flooding are both successful & support behaviourist approach, therefore raising its validity.
(A) alternative explanation: biological preparedness theory coming from evolutionary approach.

SYSTEMATI DESENSITISATION (SD)
-gradually reduces phobia through classical conditioning.
-new response is learnt of fear stimuli (counterconditioning) & relaxation can prevent anxiety (reciprocal inhibition).
1) relaxation = breath work, visualisation of peaceful scene & progressive muscle relaxation.
2) hierarchy = least feared - most feared of situations w/ the phobic stimulus hierarchy is created & user will work way up.

EVALUATION
-effectiveness: Gilroy - 3-30mths post treatment, those who received 3 SD treatments were less fearful than those who're only treated w/ relaxation, showing importance of SD & its long term effects.
-appropriateness: SD may only be helpful for specific phobias, but CBT may be required for more complex phobias to challenge irrational beliefs.
-appropriateness: SD could be more ethical as although it can produce some feelings of distress, the process is much more gradual & includes relaxation, unlike flooding, so could be better used on vulnerable ppl.

FLOODING (F)
-immediate & direct exposure to phobic stimuli.
-unable to avoid phobia through continuous exposure until anxiety lvls decrease.
-since the option of avoidance is unavailable, high lvls of anxiety cant be maintained for long time, so fear will eventually go.
-sessions last 2-3hrs, only 1 may be needed however.
EVALUATION
-effectiveness: 65% of those who received 1 long F session showed no signs of the phobia 4 yrs later, showing long term effectiveness, however, some kept the phobia, so not appropriate for all.
-appropriateness: complex phobias w/ irrational beliefs e.g. social phobias may be better treated w/ CBT, which treats phobias to specific situations.
-appropriateness: due to intense feelings of anxiety/trauma which the treatment entails, theres a high drop-out rate, which is counterproductive & can worsen phobia.

-affective/mood disorder which requires at least 5 symptoms which are consistent everyday for 2 weeks alongside impairment in general function to be diagnosed.
TYPES
1)Major depressive disorder = severe but short-term depression.
2)Unipolar = experiences depression, but no manic episodes & clinical symptoms will occur in cycles.
3)Bipolar = mixed episodes of mania & depression.
CHARACTERISTICS
-behavioural: change in activity lvls, neglecting personal hygiene + sleep disruption.
-emotional: low mood + worthlessness.
-cognitive: poor concentration + negative schemas.

ELL|** ABC
(A)ctivating event: something triggering
(B)elief: about why event occurred, can be rational or irrational
(C)onsequence: feelings/behaviour which the belief causes. in depression, irrational beliefs lead to unhealthy emotions e.g. worthlessness, anger & sadness
-the source of these irrational beliefs lie in mustabatory thinking, which is thinking certain ideas/assumptions must be true in order to be happy.

BECKs NEGATIVE TRIAD
-ppl experience depression as their thinking is biased to negative views of themselves, the world & future.
-negative triad is maintained by negative schemas developed through childhood from negative/traumatic experiences e.g. bullying/constant criticism. e.g.self-blame schema = responsible for all misfortunes, ineptness schema = expecting to always fail.
cognitive biases:
-overgeneralisation = applying 1 experience to all future ones e.g. 'i'll always fail'.
-catastrophising = exaggerating negative consequences or assuming worse outcomes.
...these self-defeating interpretations will lead to lack of motivation, low mood & hopelessness.

(R) supporting: group in early 20's had their thinking styles examined & placed in '- thinking'/'+thinking' group; 6 yrs later, 17% of '-thinking' developed depression, compared to only 1% of '+thinking". another study found depressed ppl scored higher on irrational belief measures compared to normal ppl. this shows role of negative/irrational beliefs in depression.
(I) causation: we cant conclude its faulty thinking causing depression, other factors such as neurotransmitters/genes could be the cause, so cognitive approach is limited.
(A) application: CBT was developed by cognitive explanations, & involves challenging irrational/negative thinking, increasing validity for cognitive approach.
(A) alternative: combination of biological & cognitive approach may better explain depression e.g. low serotonin.

ELLISs RATIONAL EMOTIVE BEHAVIOURAL THERAPY (REBT).
-identify & challenge negative thoughts/beliefs by interpreting them in a more positive way, in order to prevent further negative thinking/emotions.
-therapist then uses rational confrontation to reduce negative cognitive/emotional depressive symptoms.
1)empirical dispute (proof they're true)
2)logical dispute (asking if they're based on logical/common sense)
-alongside this, may ask patient to engage in more positive activities/behaviour patterns (behavioural action).

EVALUATION
-effectiveness: supporting evidence found treating major depressives w/ 14 weeks REBT, they had better outcomes than those on fluoxetine for 6 months, showing its more effective than drug therapies & also good long term solution.
-effectiveness: meta-analysis found CBT worked much better when combined w/ drug therapies than alone.
-appropriateness: requires lvl of motivation, hard for those w/ severe depression, so suggested administering of anti-depressants for period until they can engage w/ CBT.
-appropriateness: fails to address importance of social circumstances which could be contributing factor, such as poverty, as it purely focuses on altering thoughts, so inappropriate for ppl who need their circumstances changed.

OBSESSIVE COMPULSIVE DISORDER (anxiety disorder)
1) obsessions = the things ppl think about which leads to the extreme anxiety e.g. inappropriate ideas which arent based on reality, like being convinced germs are everywhere.
2) compulsions = the behaviour resulting from the obsessions e.g. uncontrollable urges to carry out repetitive behaviour like constantly washing your hands.
CHARACTERISTICS
-behavioural: compulsive behaviour + avoidance
-emotional: anxiety/distress & accompanying depression
-cognitive: obsessive thoughts + hyper-vigilance

GENETIC

family studies: prevalence of OCD was 11.7% for those w/ 1st degree OCD relatives, compared to 2.7% control group.

twin studies: MZ C-rate was 87% for obsessive symptoms, compared to 47% for DZ.

candidate genes:

-COMT gene (regulates dopamine) variation found which had higher lvls dopamine found in OCD sufferers, compared to normal ppl.

-SERT (controls transport of serotonin) causes lower lvls of serotonin, found in OCD & depression.

...however - OCD is polygenic, 230 genes found in different variations contributing to OCD.

NEURAL
Neurotransmitters-
low serotonin: associated w/ abnormal transmission of mood-related info which links to anxiety & obsessive thoughts in sufferers.
high dopamine: especially related to compulsive behaviours.
Kim Et Al: gave sufferers drugs affecting dopamine lvls which correlated w/ less obsessive behaviours.
Abnormal brain functions-
PET scans show OCD sufferers have elevated lvls in OFC & caudate nucleus.
This is the process causing this:
1) orbitofrontal cortex (responsible for turning sensory info -> thoughts/actions e.g. 'worry circuit) sends panic message
2) caudate nucleus (responsible for suppressing worry signals) is faulty so passes on panic message
3) thalamus receives message (sends back strong signal to OFC) gets excited to carry out action
4) leads to overactive worry circuit, resulting in person washing hands over & over again.

EVALUATION
(R) supporting: previous twin studies were reviewed & found 68% MZ twins sharing OCD & only 31% DZ twins.
(I) issue using twin studies: C-rates arent 100%, therefore cant be sole cause of disorder e.g. cognitions/environmental factors may be involved, so insufficient explanation.
(A) diathesis stress model: could be more genetically vulnerable, but environmental triggers have been found in history of over half OCD sufferers group, & illness was worse in those w/ 2+ traumas, so interactionist approach more suitable.

EVALUATION: NEUROTRANSMITTERS
(R) support: serotonin lvls in 169 sufferers compared to 253 non-sufferers & found lower lvls in those w/ OCD. Also found SSRI's more effective in reducing symptoms compared to placebos.
(I) causation: could be that OCD causes low lvls serotonin/ high lvls dopamine instead of these causing the illness. Also found not all sufferers responded to SSRI treatment, so limited theory.
(A) drug therapies: understanding the role of neurotransmitters helped developed SSRI's which have found to be successful in reducing symptoms.
EVALUATION: ABNORMAL BRAIN FUNCTIONS
(R) support: brain scans showed elevated activity in orbital regions/caudate nucleus compared to non-sufferers, & after treatment, lvls reduced comparably to the non-sufferers lvls.
(R) challenging: neuroimaging has not yet found impairments in the basal ganglia (where OFC & caudate nucleus located) in all OCD sufferers, & has found these impairments present in non-sufferers, showing there may be other factors involved...incomplete theory.
(I) causation: could be that OCD leads to changes in brain functions & causes overactive worry circuit, therefor limited theory.

DRUG THERAPY (Selective Serotonin Reuptake Inhibitor)

SSRIs: type of antidepressant

1) serotonin is released from pre-synaptic neuron, travels, then binds to receptors on post-synaptic neuron.

2) serotonin which isnt absorbed by post-synaptic neuron is reabsorbed to pre-synaptic.

3) SSRIs increase amount of serotonin available in synapse by preventing it being reabsorbed by pre-synaptic cell.

4) results in more serotonin available to be received by post-synaptic neuron.

OTHER DRUGS: fluoxetine may be combined w/ SSRIs, Tricyclics (given only resistant cases due to severe side effects) & SNRIs (increases serotonin & noradrenaline).

EVALUATION
effectiveness: review of 17 studies showed SSRIs were far more effective compared to placebos in treatment, being most effective at reducing symptoms between 6-13 weeks, good short-term treatment.
appropriateness: side effects of drug therapy: loss of appetite, loss of sex drive, irritability, sleep pattern disturbance and headaches, which could cause ppl to stop treatment. SSRI's found to increase suicidal thoughts/self-harm in depressed youth.
appropriateness: short-term, but may not treat underlying cause - if biological factors arent root factor & its trauma instead, psychological treatments may aid individual more e.g. CBT.