Psychopathology

Definitions of abnormality

Deviation from social norms - abnormal behaviour is seen as a deviation from unstated rules about how one 'ought' to behave. Anything that violates these rules is considered abnormal.

Evaluation:

+ Holistic - the behaviour is seen within a context so it can be judged more holistically.

- Subjective - it is very subjective and depends on who is making the judgement.

Statistical infrequency - abnormality is defined as those behaviours that are extremely rare; any behaviour that is found in very few people is regarded as abnormal.

Evaluation:

+ Objective - it uses an objective point of two standard deviations to define abnormal behaviour.

- Cultures - the definition does not consider any cultural factors that might be affecting behaviour.

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Definitions of abnormality

Failure to function adequately - people are judged on their ability to go about daily life. If they can't do this and are also experiencing distress, then it is consiedred a sign of abnormality.

Evaluation:

+ Observation - the list of behaviours can be seen by an observer; not cognitions, which would be invisible.

- Subjective - it is subjectvie and depends on an observer's point of view.

Deviation from ideal mental health - ideal mental health would include a positive attitude towards the self resistance to stress and an accurate perception of reality.

Evaluation:

+ Holistic - this is a holistic approach, looking at many variables.

- Self-actualisation - most people don't self-actualise, but we wouldn't say they are abnormal.

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Phobias

Phobias - a group of mental disorders characrised by high levels of anxiety in response to a particular stimulus or group of stimuli. The anxiety interferes with normal living.

Emotional characteristics: fear is marked and persistent, excessive and unreasonable fear.

Behavioural characteristics: avoidance, freeze or faint, fight-or-flight response and marked distress.

Cognitive characteristics: irrational thoughts and an insight.

Specific phobia - phobia of a particular object, e.g. an animal.

Social phobia - social anxiety in social situations, e.g. talking to a group of people.

Agoraphobia - fear of being in public places.

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Depression

Depression - a mood disorder where an individual feels sad and/or lacks interest in their usual activities.

Emotional characteristics: sadness, worthless, loss of interest in hobbies, emptiness, low self-esteem and anger.

Behavioural characteristics: change in activity level, increased tiredness, insomnia and change in appetite.

Cognitive characteristics: negative/irrational thoughts and an insight.

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Obsessive compulsive disorder

OCD - an anxiety disorder where anxiety arises from both obsessions and compulsions.

Emotional characteristics: anxiety, distress, embarrassment and excessive.

Behavioural characteristics: compulsive behaviours, repetitive and unrealistic.

Cognitive characteristics: recurrent, intrusive thoughts, themes (ideas, doubts, impulses or images) and an insight. 

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The behavioural approach to explaining phobias

Two-process model - a theory that explains the two processes that lead to the development of phobias.

The two processes in the model are classical conditioning (learning through association) and operant conditioning (learning through reinforcement or punishment).

Little Albert:

  • White rat (NS) = no response
  • Loud noise (UCS) = fear response (UCR)
  • Loud noise + white rat (UCS + NS) = fear response (UCR)
  • White rat (CS) = fear response (CR)
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Evaluation of behavioural approach to explaining p

+ Support for classical conditioning - a phobic person often knows of a specific indicent that started the phobia, lending support to classical conditioning.

+ Evidence - there's no other reason as to why Little Albert gains a phobia of white rats.

- Ignores cognition - it ignores cognitive factors, such as selective attention to the phobic stimulus, irrational beliefs and cognitive distortions.

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Systematic desensitisation

Systematic desensitisation - a form of behavioural therapy to treat phobias . A client is gradually exposed to the threateing situation under relaxed conditions until the anxiety reaction is extinguished.

Step 1: the client is taught progressive relaxation techniques.

Step 2: the therapist and client construct a hierarchy of fear about the object, from the least to most feared representation. These are then imagined by the client.

Step 3: the client starts with the least feared representation and uses a fear thermometer to indicate how relaxed they feel in its presence.

Step 4: the client moves up the hierarchy, slowly relaxing at each stage.

Step 5: they face the most feared representation successfully.

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Evaluation of systematic desensitisation

+ Evidence - studies have shown for it to work successfully but only for those who can learn to relax and imagine their fears while doing so.

- Ethics - it is rather distressing for the client.

- Non-specific phobias - it only works well for specific phobias, not so well for agoraphobia or social phobia.

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Flooding therapy

Flooding therapy - a form of behavioural therapy used to treat phobias and other anxiety disorders. A client is exposed to an extreme form of the threatning situaton under relaxed conditions until the anxiety reaction is extinguished.

Step 1: the client is taught progressive relaxation techniques until successful.

Step 2: the client is faced with their most feared situation with the therapist and over one long session learns to lower their panic and relax.

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Evaluation of flooding therapy

+ Cheap - it is cheaper than systematic desensitisation and it's quicker.

- Individual differences - flooding is not for every patient. It can be a highly traumatic procedure.

- Ethics - it can be seen as quite unethical even if the client has consented, and could be badly tolerated. If the client is unable to stick with it until the fear is eradicated, it could actually make them worse. Clients often go on to develop new phobias.

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Beck's negative triad

Negative triad - a cognitive approach to understanding depression, focusing on how negative expectations about the self, world and future lead to depression.

Schema - a cognitive framework that helps organise and interpret information in the brain.

Negative triad:

  • Negative view of the self, e.g. 'I am worthess'.
  • Negative view of the future, e.g. 'I am always going to be like this, nothing will change'.
  • Negative view of the world, e.g. 'no one likes me because I am so worthless. People avoid me'.

The cognitive approach sees depression as being the result of developing poor coping mechanisms through childhood. Negative thinking is triggeed by a stressor. This creates negative schemas.

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Evaluation of Beck's negative triad

+ Research support - Bates (1999) got 79 non-depressed individuals to read lots of self-statements that were negative or neutral. The negative statements created a depressed mood state, supporting the idea that exposure to negativity affects mood.

- Bipolar disorder - it does not explain all types of depression, such as bipolar disorder.

- Psychosis - someone with major depression may not feel sad and may experience psychosis, which suggests another cause.

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Ellis' ABC model

ABC model - a cognitive approach to understanding mental disorders, focusing on the effect of irrational beliefs on emotions.

Activating event (A) - a negative event occurs.

Beliefs (B) - a belief is held about the event.

Consequence (C) - an emotional response to the event.

Activating events have consequences. These are affected by our beliefs. Not everyone will think like this. It depends on the level of the emotional response in the consequence whether this will trigger depression.

Mustabatory thinking - thinking that certain ideas or assumptions must be true in order for an individual to be happy.

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Evaluation of Ellis' ABC model

+ Events trigger depression - many people become depressed because of events, such as a marriage breakdown, loss of a job or baby or failure in an exam. This is called a reactive depression and the model works well.

+ CBT - Ellis' idea of irrational beliefs can be used in cognitive behaviour therapy where it is powerful and effective. This suggests he is right about how depression is caused.

- Psychotic symptoms - it cannot explain why some people experience psychotic symptoms when depressed. Bipolar depression is sometimes associated with psychosis in which people exerience hallucinations or hear voices.

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Cognitive behavioural therapy

CBT - a combination of cognitive therapy and behavioural therapy. It aims to change an individual's thought processes; from irrational thoughts to rational thoughts.

Challenging irrational thoughts:

A - activating event    B - belief     C - consequence   D - disputing    E - effects    F - feelings

REBT (Rational emotive behaviour therapy) focuses on challenging or disputing the irrational thoughts/beliefs and replacing them with effective, rational beliefs.

Homework:

Clients are often asked to complete assignments between therapy sessions. This is to test irrational beliefs against reality and putting new rational beliefs into practice.

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Cognitive behavioural therapy

Behavioural activation:

It often involves a specific focus on encouraging depressed clients to become more active and engage in pleasurable activities.

Unconditional positive regard:

If the client feels worthless, they will be less willing to consider changing their beliefs and behaviour. However, if the therapist provides respect and appreciation regardless of what the client does and says, this will facilitate a change in beliefs and attitudes.

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Evaluation of CBT

+ Cost-effective - CBT works relatively fast and is therefore cost-effective, but it relies on well-trained therapists for its effectivenes.

- Cause or effect - we do not really know whether irrational thinking is the cause or the effect of depression. There is a correlation and that is all.

- Individual differences - CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change.

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Biological explanations of OCD

Gene - a part of the chromosome of an organism that carries information in the form of DNA.

OCD tends to run in families.

The COMT gene regulates the production of the neurotransmitter dopamine that has been implicated in OCD. One form of the COMT gene has been found to be more common in OCD patients than people without the disorder.

The SERT gene affects the transport of the serotonin, creating lower levels of this neurotransmitter. These high levls are implicated in OCD.

The diathesis-stress model suggests that there may be characteristics that are inherited the switched on by a stressful event later in life.

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Biological explanations of OCD

Abnormal levels of transmitters:

Dopamine levels are thought to be abnormally high in people with OCD. Dopamine and serotonin are two neurotransmitters whose levels affect our mood. These are both implicated in OCD. Lower levels of serotonin are associated with OCD.

Abnormal brain circuits:

Several areas in the frontal lobes of the brain are thought to be abnormal in people with OCD. The caudate nucleus normally suppresses signals from the orbitofrontal cortex (OFC). In turn, the OFC sends signals to the thalamus about things that are worrying. When the caudate nucleus is damaged, it fails to suppress minor 'worry' signals and the thalamus is alerted, which in turn, sends signals back to the OFC, acting as a worry circuit. PET scans show heightened activity in the OFC in patients of OCD.

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Evaluation of biological explanations of OCD

+ Research support - a meta-analysis of 14 twin studies of OCD found that, on average identical twins were more than twice as likely to develop OCD if their co-twin had the disorder than was the case for non-identical twins.

+ Antidepressants - some antidepressants work as serotonin reuptake inhibitors meaning that higher levels of serotonin are left in the synapse. These drugs are effective against the anxiety of some OCD sufferers, suggesting that serotonin is implicated.

- Twin studies - twin studies can be flawed because identical twins usually share a lot of similar environments as well as genes so it is hard to separate the genetic influences from the environmental ones.

- Cause or result - we do not know whether brain and neural changes cause OCD or whether they are the result of OCD.

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Drug therapy

Antidepressants - SSRIs: block the reuptake of surplus serotonin, allowing it to accumulate in the synapse so the OCD sufferer gets back to normal levels. It takes around two weeks for levels to change and usually about 6 weeks for the client to feel the effects.

Antidepressants - tricyclics: block the transporter mechanism that re-absorb both serotonin and noradrenaline into the pre-synaptic cell after it has fired. As a result, more of these neurotransmitters are left in the synapse, prolonging their activity, and easing transmission of the next impulse.

Anti-anxiety drugs: slow down the activity of the central nervous system by enhancing the activity of the neurotransmitter GABA, a neurotransmitter that, when released, has a general quietening effect on many of the neurons in the brain. They make the patient feel more relaxed

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Evaluation of drug therapy

+ Quick & easy - drug therapy is quick and easy to administer compared to waiting for CBT. It is also cheaper and a GP can administer it. It is not a cure, but it manages the symptoms.

+ No blame - having drugs allows the patient to feel like they are not to blame and that they have a medical condition.

- Side effects - side effects are serious for some with an increase in suicidal thoughts in the initial few weeks of the treatment, particularly in young people.

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