Psychopathology

Defining Psychological Abnormality

DEVIATION FROM SOCIAL NORMS:

  • Social norms = the behaviours that are acceptable, desirable or expected within a society.
  • Examples:
    • Explicit - do not steal/muder, obey speed limits
    • Implicit - manners, no cheating
  • So abnormal behaviour is behaviour which goes against or violates what is socially acceptable, desirable or expected.
    • E.g. showing inappropriate affect (emotion) such as laughing when someone has died.
  • Evaluation:
  • Strengths:
    • Helps people - society gives itself the right to intervene in abnormal people's lives and can be beneficial, as such individuals that need it may not be able to get help themselves.
    • Developmental norms - the definition established what behaviours are normal for different ages.
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Defining Psychological Abnormality

DEVIATION FROM SOCIAL NORMS:

Evaluation:

  • Strengths:
    • Protects society - the definition seeks to protect society from the effects an individual's abnormal behaviour can have on others.
  • Limitations:
    • Change over time - the norms defined by society often relate to moral standards that vary over time as social attitudes change. E.g. homosexuality was not removed the International Classification of Diseases classification of mental disorders until 1990.
    • Individualism - those who do not conform to social norms may not be abnormal, but merely individualistic or eccentric and not problematic in any sense.
    • Cultural differences - social norms vary within and across cultures and so it is diffcult to know when they are being broke, therefore this is an example of cultural relativisim.
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Defining Psychological Abnormality

FAILURE TO FUNCTION ADEQUATELY:

  • Functioning adequately = behaving in waysw that allow you to cope with all the day-to-day tasks that you have to do.
  • ROSENHAN & SELIGMAN (1989) suggested 7 abnormal characteristics:
    • Personal distress -could include depression and anxiety disorders
    • Maladaptive behaviour -behaviour that stops individuals from attaining satisfactory goals, both socially and occupationally
    • Unpredictability -behaciour that wouldn't be expected or predicted
    • Irrationality -behaviour that cannot be explained in a rational way
    • Observer discomfort -behaviour that causes distress or discomfort to others
    • Violation of moral standards -behaviour that doesn't fit in with society's standards
    • Unconventionality -showing unconventional behaviour.
  • So abnormal behaviour is showing some or all of these characteristics in a way that means they are not functioning on a day-to-day basis.
  • In order to define how abnormal someone is, the criteria need to be read as follows - the more characteristics someone shows, the more likely that they are abnormal.
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Defining Psychological Abnormality

FAILURE TO FUNCTION ADEQUATELY:

Evaluation:

  • Strengths:
    • Matches sufferers' perception - as most people seeking clinical help believe that they are suffering from psychological problems that interfere with the ability to function properly, it supports the definition.
    • Observable behaviour - it allows judgement by others of whether individuals are functioning properly, as it focuses on observable behaviours.
    • Checklist - the definition provides a practical checklist individuals can use to assess their level of abnormality.
  • Limitations:
    • Abnormality is not always accompanied by dysfunction - psychopaths, people with dangerous personality disorders, can cuase great harm yet still appear normal. E.g. Harold Shipman, the English doctor who murdered at leas 215 of his patients over a 23-year period, seemed to be a respectable doctor.  He was abnormal, but didn't display features of dysfunction.
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Defining Psychological Abnormality

FAILURE TO FUNCTION ADEQUATELY:

Evaluation:

  • Limitations:
    • Normal abnormality - there are times in people's lives when it is normal to suffer distress, like when loved ones die.  Grieving is pyschologically healthy to overcome loss.  The definition doesn't consider this.
    • Cultural differences - what is considered normal functioning varies from culture to culture and so abnormal functioning of one culture should not be used to judge people's behaviour from other cultures and subcultures.
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Defining Psychological Abnormality

DEVIATION FROM IDEAL MENTAL HEALTH:

  • Ideal mental health = meeting the criteria for perfect psychological wellbeing.
  • JAHODA (1958) turns the traditional notion of abnormality on its head by looking at positives rather than negatives - mental health instead of mental illness.
  • Identified 6 major criteria:
    • Positive attitude towards oneself -having self-respect and a positive self-concept.
    • Self-actualisation -experiencing personal growth and development. Becoming everything one is capable of becoming.
    • Autonomy -being independent, self-reliant and able to make personal decisions.
    • Resisting stress -having effective coping strategies and being able to cope with everyday anxiety-provoking situations.
    • Accurate perception of reality -perceiving the world in a non-distorted fashion.  Having an objective and realistic view of the world.
    • Environmental mastery -being competent in all aspects of life and able to meet the demands of any situation. Having the flexibility to adapt to changing life circumstances.
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Defining Psychological Abnormality

DEVIATION FROM IDEAL MENTAL HEALTH:

  • So abnormal behaviour is deviating from the 6 criteria.
  • In order to define how abnormal someone is, the criteria need to be read as follows - that anyone who does not meet all 6 of these criteria would be considered abnormal.  All criteria need to be met in order to be seen as normal.
  • Evaluation:
  • Strengths:
    • Positivity - the definition emphasises positive achievements rather than failures and distress and stresses a positive approach to mental problems by focusing on what is desirable, not undesirable.
    • Targets areas of dysfunction - the definition allows targeting of which areas to work on when treating abnormality.  This could be important when treating different types of disorders, such as focusing upon specific problem areas a person with depression has.
    • Goal setting - the definition permits identification of exactly what is needed to achieve normality, allowing creation of personal goals to work towards and achieve, thus facilitating self-growth.
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Defining Psychological Abnormality

DEVIATION FROM IDEAL MENTAL HEALTH:

  • Evaluation:
  • Strengths:
    • Over-demanding criteria - most people do not meet all the ideals.  For example, few people experience personal growth all the time.  Therefore, according to this definition, most people are abnormal.  Thus the criteria may actually be ideals (how you would like to be) rather than actualities (how you actually are).
    • Subjective criteria - many of the criteria are vague and difficult to measure.  Measuring physical health is more objective using methods like X-rays and blood tests.  Diagnosing mental health is more subjective, relying largely on self-reports of patients who may be mentally ill and not reliable.
    • Non-desirability of autonomy - collectivist cultures stress communal goals and behaviours and see autonomy as undesirable. Western cultures are more concerned with individual attainment and goals, so the definition is culturally biased.
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Defining Psychological Abnormality

STATISTICAL INFREQUENCY:

  • Statistical infrequency = behaviours that are rare.
  • A normal distribution curve shows whether someone's behaviour falls within the normal distribution (i.e. close to the mean, it occurs in the majority of people of a population) or outside of it. If the behaviour is outside of the ND (2 or more standard deviation points way from the mean), the behaviour occurs in only 5% of the populartion and is therefore statistically infrequent.
  • So abnormal behaviour is behaviour or characteristics more than 2 standard deviations away from the mean (below or above it).  This means the behaviour is so statistically rare that it occurs in only 5% or less of all people of a population.
  • Evaluation:
  • Strengths:
    • Objectivity - once a way of collecting data about a behaviour/characteristics and a cut-off point has been agreed, it becomes an objective way of deciding who is abnormal.
    • Based on real data - the definition relies on real, unbiased data and so again is an objective means of defining abnormality.
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Defining Psychological Abnormality

SATISTICAL INFREQUENCY:

Evaluation:

  • Strengths:
    • Overall view - the definition gives an overview of what behaviours and characteristics are infrequent within a given population.
  • Weaknesses:
    • Where to draw the line - it's not clear how far behaviour should deviate from the norm to be seen as abnormal.  Many disorders like depression, vary greatly between individuals in terms of their severity.
    • Not all infrequent behaviours are abnormal - some rare behaviours and characteristics are desirable rather than being undesirable.  E.g. being highly intelligent is statistically rare, but desirable.
    • Not all abnormal behaviours are infrequent - some statistically frequent normal behaviours are actually abnormal.  About 10% of people will be chronically depressed at some point in their lives, which suggests depression is so common as to not be seen as abnormal under this definition.
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Phobias

  • Phobias are a type of anxiety disorder. Anxiety is a natural human response to dangerous situations to prevent us from putting ourselves into dangerous, potentially life-threatening situations. However, phobias are characterised by uncontrollable, extremely irrational and enduring fears. They involve anxiety levels that are out of proportion to any actual risk.
  • Symptoms:
  • Behavioural:
    • Avoidant/anxiety respons - avoiding the anxiety provoking object or stimulus.
    • Disruption of functioning - the anxiety or avoidance response is so severe that it impacts on everyday life (e.g. work and social life).
  • Emotional:
    • Persistent fear - due to the anticipation of the anxiety provoking sitmulus.
    • Panic attacks - from exposure to the anxiety provoking stimulus.
  • Cognitive:
    • Awareness - that the fear response is overstated.
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Phobias

SUB-TYPE OF PHOBIAS:

  • Simple phobias: - phobias of specific objects/situations/environments.
    • animal phobias - e.g. arachnopobia and mottephobia.
    • injury phobias - e.g. haematophobia and scotomaphobia.
    • situational phobias - e.g. aerophobia and gephydrophobia.
    • natural environment phobias - e.g. hydrophobia and nephophobia.
  • Social phobias: - being over anxious in social situations. Involve the perception of being judged and feeling inadequate. Often find conducting meaningful relationships difficult.
    • performance phobias - being anxious about performing in public.
    • interaction phobias - being anxious about mixing with others
    • generalised phobias - being anxious about situations where other people are present.
  • Agoraphobia:
    • the fear of leaving home or a safe place. Often occus with panic attackd, where sufferers experience panic first and the anxiety generated makes them vulnerable in open spaces.
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Depression

  • Depression is an affective mood disorder including lengthy disturbance of emotions.
  • 20% of people will develop depression at some point in their lifetime.
  • Women are more likely to develop it than men.
  • An episode of depression generally lasts between 2 and 6 months.
  • The suicide rate in severely depressed people is 10%.
  • UNIPOLAR DEPRESSION:
    • Also known as major depression.
    • At leadt 5 symptoms must be apparent every day for 2 weeks for diagnosis to be made.
    • Up to 25% of women and 12% of men will suffer from unipolar depression.
  • BIPOLAR DEPRESSION:
    • Also known as manic depression.
    • Mixed episodes of mania and depression.
    • Less common than unipolar - about 2% of people suffer from it, equally divided between the sexes.
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Depression

  • Symptoms of unipolar depression:
    • Behavioural:
      • Loss of energy (fatigue, inactivity)
      • Reduced levels of social interaction
      • Disturbed sleep patterns
      • Poor personal hygiene
      • Significant weight changes
    • Emotional:
      • Loss of enthusiasm and pleasure
      • Constant depressed mood (overwhelming feelings of sadness/hopelessness)
      • Worthlessness and/or guilt
    • Cognitive:
      • Delusions (such as personal inadequacy, guilt or disease)
      • Poor concentration and memory
      • Thoughts of death and/or suicide
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Depression

  • Symptoms of bipolar depression:
    • Behavioural:
      • High energy levels
      • Reckless behaviour (risk-taking)
      • Talkative (fast speech)
    • Emotional:
      • Elevated mood states (euphoria)
      • Irritability
      • Lack of guilt
    • Cognitive:
      • Delusions (think they are grandiose)
      • Irrational thought processes (irrational decision making)
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OCD

  • OCD is an anxiety disorder where people experience persistent and intrusive thoughts occurring as obsessions, compulsions or a combination of both.
  • Obsessions are inappropriate or forbidden ideas that aren't real.
  • Compulsions are intense, uncontrollable urges to perform tasks reptitively.
  • Compulsions are an attempt to reduce distress or prevent feared events.
  • Preoccupations with contamination and cleaning  are more commong in females, while males focus more on religious and sexual obsessions.
  • Symptoms (obsessions):
    • Behavioural:
      • Hinder everyday functioning - having obsessive ideas of a forbidden or inappropriate type creates such anxiety that the ability to perform everyday functions is severely hindred, e.g. being able to work effectively.
      • Social impairment - anxiety levels generated are so high as to limit the abilit to conduct meaninful interpersonal relationships.
    • Emotional:
      • Extreme anxiety - persistent inappropriate or forbidden ideas create excessively high levels of anxiety.
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OCD

  • Symptoms (obsessions):
    • Cognitive:
      • Recurrent and persistent thoughts - sufferers experience constantly repeated obsessive thoughts and ideas of an intrusive nature.
      • Recognised as self-generated - most sufferers understand their obsessional thoughts, impulses and images are self-invented and not inserted externally.
      • Realisation of inappropriateness - most sufferers understand their obsessive thoughts are inappropriate, but cannot consciously control them
      • Attentional bias - percpetion tends to be focused on anxiety-generating stimuli.
  • Symptoms (compulsions):
    • Behavioural:
      • Repetitive - sufferers feel compelled to repeat behaviours as a response to their obsessive thoughts, ideas and images.
      • Hinder everyday functioning - repetitive, compulsive behaviours disrupt functions.
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OCD

  • Symptoms (compulsions):
    • Behavioural:
      • Social impairment - the performance of repetitive, compulsive behaviours can seriously affect the ability to conduct meaningful interpersonal relationships.
    • Emotional:
      • Distress - the recognition that compulsive behaviours cannot be consciously controlled can lead to strong feelings of distress.
    • Cognitive:
      • Uncontrollable urges - sufferers experience uncontrollable urges to perform acts they feel will reduce the anxiety causes by obsessive thoughts.
      • Realisation of inappropriatness - sufferers understand their compulsions are inappropriate, but cannot consciously control them.
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Behavioural approach: Explaining/Treating Phobias

  • Behaviourists argue that phobias are being learned through association.
  • There are 2 types of associative learning:
    • Classical conditioning
    • Operant conditioning
  • The 2 process model:
    • Explains the acquisition of phobias through classical conditioning.
    • Explains the maintenance of phobias through operant conditioning.
  • CLASSICAL CONDITIONING:
    • Theory based on Ivan Pavlov's research.
    • A natural stimulus that causes fear response becomes associated with a neutral stimulus.
    • The neutral stimulus then causes fear.
    • Example:
      • Before conditioning: NS (dogs) = no fear. UCS (dog bite) = UCR (fear)
      • During conditioning: NS (dogs) + UCS (dog bite) = UCR (fear)
      • After conditioning: CS (dogs) = CR (fear)
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Behavioural Approach: Explaining/Treating Phobias

  • OPERANT CONDITIONING:
    • Based on that assumption that we learn through the consequences of behaviour.
    • If a behaviour is being rewarded, the person showing the bheaviour is more likely to repeat it. Phobias can be learned through positive reinforcement (receiving a positive reward for the behaviour shown) and negative reinforcemet (taking something unpleasant/negative away). Phobias are maintained by avoiding the negative stimulus (the fear stimulus). That is, the more someone avoids contact with their feared object/situation, the less fear they will feel.  However, this negatively reinforces the avoidant behaviour.  Therefore, a persons' levels of fear will stay high whenever they are confronted with their feared object.
    • Negative reinforcement - They avoid the stimulus/object that causes fear. Avoidance behaviour is negatively reinforced because it removes anxiety. This maintains the phobia because always avoiding the stimulus, means that irrational fears cannot be dealt with/confronted.
    • Positive reinforcement - The sufferer may get attention/comfort when they are anxious because of the stimulus.  Therefore they are being positively reinforced.  This maintains the phobia because they are being rewarded for the behaviour shown.
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Behavioural Approach: Explaining/Treating Phobias

  • Key research studies: LITTLE ALBERT - WATSON & RAYNER (1920), KING ET AL (1998), BAGBY (1922)
  • Evaluation:
  • Strengths:
    • Treatments for phobias are based on the 2-process model.  As they ahve been proven to be very effective, they support the behaviourist explanation of phobias.
    • Behavioural explanations can be combined with biological explanations (e.g. a combination of genetic predisposition for phobias and certain environmental factors such as whether someone has experienced a traumatic event of not can make some people more liekly to develop phobias than others.
  • Weaknesses:
    • Not everyone who experiences a traumatic event will automatically develop a phobia.
    • RACHMAN (1984) has criticised the 2-process model,  They argue that people with phobias do not necessarily avoid feared objects to reduce their fears but to gain positive feelings.  The avoidance response is rather used to give them a feeling of safety.  RACHMAN calls this the safety signals hypothesis.
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Behavioural Approach: Explaining/Treating Phobias

  • Evaluation:
    • Weaknesses:
      • BOUNTON (2007) argues that the 2-process model does not take into account any evolutionary explanations for the development and maintenance of phobias.  They suggests that avoidance behaviour is acquired faster, if the avoidance response can be compared to natural defence mechanisms which are typically displayed in animales, e.g. running away, playing dead, hiding, natural defence mechanisms.
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Behavioural Approach: Explaining/Treating Phobias

TREATMENT OF PHOBIAS:

  • Behaviourists argue that phobias are acquired and maintained through classical and operant conditioning.
  • Therefore it is assumed that phobias can be unlearned in the same way as they had been learned.
  • 2 major types of treatment for phobias:
    • Systematic desensitisation (SD)
    • Flooding (Implosion
  • SYSTEMATIC DESENSITISATION:
    • Based on classical conditioning and uses reverse counter conditioning).
    • It aims to replace a fear to a situation/object with another healthy response (relaxation) to the situation or object.
    • 1. Relaxation - typically, SD starts with teaching an individual how to relax using muscle relaxation techniques.
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Behavioural Approach: Explaining/Treating Phobias

TREATING PHOBIAS:

  • SYSTEMATIC DESENSITISATION:
    • 2. Hierarchy of anxiety provoking situations - the therapist and client then create a graded series (a hierarchy) of anxiety provoking situations starting with those that arouse least anxiety and fradually progressing to those that arouse most anxiety.  Scenarios along the hierarchy are either imagined (covert desensitisation) or real (in vivo desensitisation).
    • 3. Reciprocal inhibition - They then work up through the hierarchy while practicising the relaxation techniques.  It is not physically possible to experience a fear response and relaxation at the same time so if the client can remain relaxed their fear response should disappear.
    • If the client starts to feel fear at any point and cannot stay relaxed then they will go back down a step in the hierarchy and try again.  Treatment is complete when the client has managed to work through the complete hierarchy without fear.  They may require several sessions to reach this stage.
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Behavioural Approach: Explaining/Treating Phobias

TREATING PHOBIAS:

  • FLOODING:
    • This is the most extreme form of behavioural therapy for phobias.
    • In order to demonstrate the irrationality of the fear, the therapist puts the client streaight into a situation where they would face their phobia at its worst.
    • Flooding usually uses in-vivo desensitisation actual exposure to the feared stimulus, rather than covert desensitisation.
    • The adrenaline and fear response the client perceives has a time-limit, theoretically a person will eventually have to calm down and realise that their phobia is unwarranted.
  • Key research studies: BROSNAN & THORPE (2006), WOLPE (1960), OST (1997), BARLOW (2002)
  • Evaluation:
    • Strengths:
      • Even though SD and flooding raise ethical issues, the long-term benefits of the therapy outweight the short-term costs of distress.
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Behavioural Approach: Explaining/Treating Phobias

TREATING PHOBIAS:

  • Evaluation:
    • Weaknesses:
      • SD and flooding raise ethical issues because they involve exposing patients to things they are afraird of and thus making them anxious (causing psychological harm).  Flooding can also cause physical harm (for example, high levels of anxiety can increase the risk of heart attacks, if the patients already have some health problems).
      • Behavioural treatments such as SD and flooding are not effective for all types of phobias(for example, they were found to be less effective in the treatment of social phobias).
      • Learning to cope with imagined feared objects/situations (covert desnsitisation) does not necessarily mean that the patients will be able to face them in real life (in vivo situations).
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Cognitive Approach: Explaining/Treating Depression

  • Behaviour is primarily affected by an individual's cognitions (thoughts, beliefs, perceptions, etc).
  • Depression is therefore thought to be caused by faulty cognitiions, such as irrational beliefs or overly negative thoughts.
  • 2 models to explain depression:
  • BECK'S NEGATIVE TRIAD:
    • BECK's (1987) model of depression involves three negative schemata.
    • BECK argues that depressed people characteristically think in a negative way about:
      • Negative views about the world, e.g. no-one likes me
      • Negative views about the future, e.g. I'll never be able to do it
      • Negative views about oneself, e.g. I'm useless
    • These negative views about oneself, the world and the future are usually based on a combination of negative schemas and cognitive biases. Many of our schemata develop on the basis of our early experience. Traumatic or unhappy experiences early in life may lead to the development of negative schemata.
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Cognitive Approac: Explaining/Treating Depression

  • BECK'S NEGATIVE TRIAD:
    • This can be the result of authority figures such as parents being overcritical and placing unrealistic demands on their children
    • Types of negative schemas that might have developed in early childhood:
      • Ineptness schema - make depressives expect to fail.
      • Self-blame schemas - makes depressives feel responsible for their failures and misfortunes.
      • Negative self-evaluation schemas - constantly remind depressives of their worthlessness.
    • Very often, these negative schemas are then fed by cognitive biases leading to a misperception of reality.
      • Types of cognitive biases:
        • Aribitrary inference - conclusions drawn in the absence of sufficient evidence.
        • Selective abstraction - conclusions drawn from just one part of a situation.
        • Overgeneralisation - sweeping conclusions drawn on the basis of a single event.
        • Magnification & minimisation - exaggeration in evaluation of performance
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Cognitive Approach: Explaining/Treating Depression

  • ELLIS' ABC MODEL:
    • ELLIS suggested that people suffering from depression tend to blame external events for their negative feelings.
    • However, this model suggests that it is rather their interpretation of the events that causes their symptoms of depression.
    • An activating event (A) in an individual's life will lead to a belief about why this event happened (B).
    • The person will then draw a consequence out of this event (C) based on their beliefs about it.
    • Rational beliefs will lead to desirable emotions and behaviours, while irrational beliefs will lead to undesirable emotions and behaviours.
  • Key research studies: BEEVERS ET AL (2010), BOURY ET AL (2001), SAISTO ET AL (2001)Evaluation:
  • Strengths:
    • Extensive research evidence suggests that depression can be related to negative thoughts and misperception of events.
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Cognitive Approach: Explaining/Treating Depression

  • Evaluation:
    • Strengths:
      • Those therapies that are based on cognitive explanations of depression have been proven to be most effective, strengthening the assumption that the disorder might be a result of faulty cognition.
      • Other explanations are also taken into account (e.g. behavioural approach) to explain why some people have developed negative thinking patterns that can lead to depression.
    • Weaknesses:
      • The cognitive explanations have been criticised because not everyone with depression has a negative belief about events and therefore not necessarily showing all of the negative views that BECK has proposed.
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Cognitive Approach: Explaining/Treating Depression

ALTERNATIVE EXPLANATIONS OF DEPRESSION: GENETIC EXPLANATION:

  • Centres on the idea that vulnerability to depression is inherited.
  • Generally researched through twin and adoption studies, though more recently gene-mapping studies have been used that compare genetic material from those with high and low incidences of the disorder.
  • Key research study: WENDER ET AL (1986)
  • Evaluation:
    • The similarity of symptoms across gender, age and cultural groups, plus the similarity in physical symptoms, suggests a genetic rather than a cognitive influence, though of course the cognitive features of depression may be genetically mediated, which again suggests the 2 explanations can be combined rather than seen as separate.
    • If the genetic explanation was solely true, then concordance rates between MZ twins would be 100% and all depressives would share genetic material, which they don't.  So although research does indicate a genetic influence, other influences, such as cognitive factors, must also play a role.
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Cognitive Approach: Explaining/Treating Depression

ALTERNATIVE EXPLANATION OF DEPRESSION: BEHAVIOURAL EXPLANATION:

  • Sees depression as a learned condition.
  • LEWINSOHN (1974) proposed that negative life events may incur a decline in positive reinforcements and even lead to learned helplessness, where individuals learn through experience that they seemingly can't bring about positive life outcomes.
  • Depression could result from social learning through the observation and imitation of depressed others.
  • Key research study: COLEMAN (1986)
  • Evaluation:
  • Overall, there is little research evidence that solidly backs up behaviourist explanations, while the cognitive approach is supported by a body of research based evidence, which strongly suggests the cognitive explanation to be superior.
  • KANTER ET AL (2008) state that behaviourism cannot offer an account of depression that addresses its complexity satisfactorily.  Cognitive explanations are more able to do this, as they can account for the irrational thought processes that underpin the condition.
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Cognitive Approach: Explaining/Treating Depression

TREATING DEPRESSION:

  • Cognitive-behavioural therapy (CBT) is the most common treatment of depression.
  • CBT is an umbrella term for a number of therapies.
  • The aim of CBT:
    • In its simplest form, CBT is about encouraging the client to be more positive and optimistic, but it is more complex than that.
    • CBT aims to change self-defeating beliefs by encouraging people to examine their beliefs and expectations that underlie their unhappiness and to replace irrational, negative thoughts with a more positive, adaptive pattern of thinking.
    • One way of doing this is to identify the negative thoughts and then alter the irrational beliefs.  It helps the client to see that they are irrational by providing evidence to the contrary.
    • Therapists and clients work together to set new goals for the clients in order that more positive and rational beliefs are incorporated into their way of thinking.  It is assumed that patients can only change their maladaptive behaviour by changing the underlying maladaptive thoughts.
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Cognitive Approach: Explaining/Treating Depression

TREATING DEPRESSION:

  • 2 major types of CBT:
    • Rational emotive behaviour therapy (REBT)
    • Treatment of automatic negative thoughts
  • REBT:
    • Education phase - patients learn the relationship between thoughts, emotions and their behaviour.  ELLIS' ABC model is used to identify the client's irrational beliefs, which may be causing their depression.
    • The therapy involves challenging or disputing these irrational beliefs by suggesting an alternative more rational and healthy belief about the activating event.  This is called reframing.
    • Behavioural activation and pleasant event scheduling - patients are then sent off to increase their physical activity and to socialise with others.  Between sessions patients are applying techniques that boost their self-esteem, e.g. test/dispute negative thoughts.  Therapists only set achievable goals to avoid a relapse of a patient's negative way of thinking.
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Cognitive Approach: Explaining/Treating Depression

TREATING DEPRESSION:

  • Key research studies: EMBLING (2002), LINCOLN ET AL (1997), DAVID ET AL (2008)
  • Evaluation:
    • Strengths:
      • CBT is the most effective psychological treatment for moderate and severe depression and one of the most effective treatments where depression is the main problem. Also very effective in stopping mild depression from developing into severe depression.
      • Has few side-effects.
      • The application of CBT occurs over relatively short time periods compared to other treatments and is more cost effective than such treatments.  CBT also has long-term benefits, as the techniques involved are used continually to stop symptoms returning.
      • The better trained the therapist, the better the therapeutic outcomes, which illustrates how the use of trained therapists is essential to the treatment's effectiveness.
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Cognitive Approach: Explaining/Treating Depression

TREATING DEPRESSION:

  • Evaluation:
    • Weaknesses:
      • There are ethical concerns with CBT as it can be too therapist centred.  Therapists may abuse their power of control over patients, forcing them into certain ways of thinking and patients can become too dependent on therapists.
      • CBT is difficult to evaluate.  SENRA & POLAINO (1998) found that the use of different measurement scales to assess CBT produced different measures of improvement among patients.
      • For patients with difficulty concentrating, often problematic with depressives, CBT can be unsuitable, leading to feelings of being overwhelmed and disappointed, which strengthens depressive symptoms rather than reducing them
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Biological Approach: Explaining/Treating OCD

  • In the biological approach psychological disorders can be explained with 3 main factors:
    • Genetics
    • Neurotransmitters
    • Hormones
  • For OCD the focus is on:
    • Genetic explanations
    • Neural explanations
  • GENETIC EXPLANATIONS:
    • OCD is assumed to be due to genetic inheritance.
    • The majority of research studies have focused on twin studies.
    • However, a weakness of twin studies is that they fail to separate biological factors from environmental factors.
    • More recently, gene-mapping studies have found further support for a genetic link to OCD.
    • Twin studies compare the concordance rates for OCD between MZ and DZ rwins.
    • Concordance rates = the percentage of instances where both twins in a pair have the disorder.
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Biological Approach: Explaining/Treating OCD

GENETIC EXPLANATIONS:

  • If the concordance rate is higher in MZ than for DZ then this indicates that there is genertic influence on the cause of the disorder.
  • However, if this is not 100% then there are environmental factors influencing.
    • MZ twins are more likely to be treated very similarly, which is very different to DZ twins.
  • Gene-mapping studies compare the genetic material from those suffering with the disorder and those without.
  • Gene-mapping of OCD indicates that it is likely that there is a combination of genes that determine vulnerability to the condition rather than that specific genes cause OCD.
  • There is some genetic similarity between OCD and Tourette's syndrome but they are still thought to be 2 separate disorders.
  • Key research studies: GROOTHEEST ET AL (2005), LENANE ET AL (1990), SAMUELS ET AL (2007).
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Biological Approach: Explaining/Treating OCD

GENETIC EXPLANATIONS:

  • Evaluation:
    • No research has found concordance rates in MZ twins to be 100%, therefore there must be environmental influences on OCD as well.
    • Research has found that there is no such thing as the OCD gene but the disease was rather found to be linked to a variety of genes that all contribute to it in small amounts.
    • Even though research has found that OCD is due to genetic inheritance, there is little research that has looked at the actual genetic mechanisms of the disorder.
    • Even though OCD was found to be linked to genetics, it is unclear whether different types of OCD have different degrees of inheritance (i.e. some types of OCD might have a stronger genetic link than others).
    • Sufferers of OCD within the same family do not necessarily share the same symptoms of OCD (a father might have a fear of germs, whereas his daughter needs to check the door lock 5 times).  If OCD is heritable, shouldn't they display the same symptoms?
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Biological Approach: Explaining/Treating OCD

NEURAL EXPLANATIONS:

  • Damage to neural mechanisms - some forms of OCD have been linked to breakdown in immune system functioning cause by pathogens such as throat infections, Lyme's disease and influenza.  Lowered immune function may lead to damage to neural mechanisms.  This seems to occus more often in children than adults.
  • Serotonin - low levels of serotoning activity found in brains of OCD sufferers.  Drugs that increase the levels of serotonin reduce symptoms of OCD in sufferers.  These facts suggest that serotnoin plays a role in OCD.
  • Differences in brain activity between OCD sufferers and non-sufferers - PET scans show OCD sufferers often have high levels of activity in the orbital frontal cortex - the brain areas is involved in conversion of sensory information into thoughts, particularly in helping to initate activity upon receiving impulses to act and then to stop the activity when the impulse lessens.  OCD sufferers with an overactive orbital frontal cortex are unable to stop acting on impulses.
  • Key research studies: PICHICHERO (2009), FALLON & NIELDS (1994), ZOHAR ET AL (1987), HU (2006), SAXENA & RAUCH (2000)
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Biological Approach: Explaining/Treating OCD

NEURAL EXPLANATIONS:

  • Evaluation:
    • Infections - infections that reduce immune systems functioning don't actually cause OCD but they might trigger OCD symptoms in those with a genetic vulnerability to the disorder (e.g. a family history of OCD).  Diathesis-stress model.
    • Cause or effect - it is not clear whether abnormal levels of serotonin causes symptoms of OCD or whether they are the effect of having the disorder.
    • Low levels of serotonin not the only explanation - not all OCD sufferers respond positively to serotonin increasing drugs.  This suggests that low levels of serotonin might not be the only explanation of OCD.
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Biological Approach: Explaining/Treating OCD

TREATING OCD:

  • Biological treatments for OCD aim to correct the biological abnormalities that cause the obsessions and compulsions.
  • DRUG THERAPY:
  • Antidepressants - selective serotonin reuptake inhibitors (SSRIs) block (inhibit) the re-absorption (re-uptake) of serotoning in the brain's receptor cells.  This blocking action means there is more serotoning available and causes the orbital frontal cortex to function normally.  One of the most common antidepressants to treat OCD is prozac (fluoxetine).
  • Anxiolytic drugs - lower anxiety levels by increasing the activity of the neurotransmitter GABA (has a claming effect).  One of the most common drugs is valium (benzodiazepine).
  • Antipsychotic drugs - lower-dopamine levels (to reduce compulsions). They are only prescribed, if treatment with SSRIs was not effective or if patients cannot take SSRIs due to their severe side effects.  One of the most common drugs is risperidone.
  • Key research studies: KORAN ET AL (2000), CICCERONE ET AL (2000), JULIEN (2007)
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Biological Approach: Explaining/Treating OCD

TREATING OCD: DRUG THERAPY:

  • Evaluation:
    • Strengths:
      • Cost effective - drug treatment is relatively cheap and it does not require a therapist.
      • Quick - it is extremely quick to take a drug.
    • Weaknesses:
      • Not a cure of OCD - drugs reduce the symptoms of OCD but they don't cure the disorder.
      • Side effects - irritability, sleep problems, headaches, loss of appetitie, loss of sexual ability, weight gain, suicidal thoughts.
      • Treatment of OCD symptoms or lessening of depressive symptoms - it is not clear whether drugs reduce OCD symptoms or the depressive symptoms that accompany the disorder.
      • Better treatments available - antidepressants should not be used for the treatment of OCD because of their severe side effects (suicidal thoughts).
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Biological Approach: Explaining/Treating OCD

TREATING OCD:

  • PSYCHOSURGERY:
    • Destruction of brain tissue to disrupt the corticostriatal circuit by using radio-frequency waves.  This has an effect on the orbital frontal cortex and reduces the symptoms of OCD.
    • Deep brain stimulation with magnetic impulses on the supplementary motor area of the brian.  The brain area is associated with blockng out irrelevant thougths and obsessions.
    • Key research studies: RICHTER ET AL (2004), MALLETT ET AL (2008)
    • Evaluation:
      • Acceptable treatment - despite a relatively small success rate and serious side-effects, psychosurgery is an acceptable treatment for those OCD patients who didn't respond to other treatments.
      • An alternative to drug treatment - it was found that 10% of OCD patients get worse when undergoing drug treatment, so psychosurgery may be an alternative treatment
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