Psychopathology Revision Cards

• Can count the number of times we observe a behaviour that isn't usual or 'normal' = abnormal.
• Eg - we can say that at any one time, only a small number of people will have an irrational fear of buttons.
• Statistical deviation - Occurs when an individual has a less common characteristic; for example being more depressed or less intelligent than most of the population.

EXAMPLE: IQ AND INTELLECTUAL DISABILITY DISORDER

• Intelligence can be reliably measured.
• We know that in any human characteristic, the majority of people's scores will cluster around the average, and that the further we go above or below that average, the fewer people will attain that score = normal distribution.
• The average IQ is set at 100. 68% have an IQ in the range from 85 to 115.
• 2% are below 70 = unusual/abnormal = intellectual disability disorder (mental retardation).

(+) Real-life application

• Diagnosis of intellectual disability disorder.
• All assessment of patients with mental disorders includes some kind of measurement of how severe their symptoms are as compared to statistical norms = useful.

(-) Unusual characteristics can be positive

• IQ stores over 130 are just as unusual as those below 70, but super-intelligence is not considered to be an undesirable characteristic that needs treatment.
• Therefore, SD cannot be used alone to make a diagnosis.

(-) Not everyone unusual benefits from a label

• Someone with a very IQ but who was not distressed, quite capable of working, would simply not need a diagnosis of intellectual disability.
• If that person was 'labelled' as abnormal, this might have a negative effect on the way others view them & how they view themselves.

• Behaviour that is different from the accepted standards of behaviour in a community/society.
• Groups of people choose to define behaviour as abnormal on the basis that it offends their sense of what is acceptable of the norm. We are making a collective judgement as a society about what is right.

NORMS ARE SPECIFIC TO THE CULTURE WE LIVE IN

• May be different for each generation & every culture, so there are relatively few behaviours that would be considered universally abnormal on the basis that they breach social norms.
• Eg - homosexuality continues to be viewed as abnormal in some cultures & was considered abnormal in our society in the past.

EG - ANTISOCIAL PERSONALITY DISORDER (psychopathy)

• These people are impulsive, aggressive & irresponsible. DSM-5 says that one important symptom of APD is an 'absence of prosocial internal standards associated with failure to conform to lawful/culturally normative ethical behaviour.'
• = we are making social judgement that a psychopath is abnormal as they don't conform to moral standards. It would be considered abnormal in a wide range of countries.

(-) Not a sole explanation

• Real-life application in the diagnosis of APD. There is threfore a place for deviation from social norms in thinking about what is onrmal and abnormal.
• However, there are other factors to consider, eg - the distress to other people resulting from APD (the failure to function definition - can't cope with everyday demands).

(-) Cultural relativism

• Vary from one generation to another & one community to another.
• Eg -  a person from one cultural group may label someone from another culture as behaving abnormall according to their standards, rather than the standards of that person.
• Eg - hearing voices is socially acceptable in some cultures but would be a sign of a mental abnormalityi n the UK = problems for people from one culture living with another.

(-) Can lead to human rights abuses

• Too much reliance on deviation from social norms to understand abnormality can also lead to systematic abuse of human rights.
• Classification = ridiculous nowadays as our social norms have changed. More radical psychologists suggest that some of our modern catergories of mental disorder are really abuses of people's rights to be different.

• May cross line between normal & abnormal at the point when they can no longer cope with the demands of everyday life and they fail to function adequately.
• Someone is not functioning adequately when they are unable to maintain basic standards of nutrition and hygiene, or hold down a job/maintain relationships with people around them.

When is someone failing to function adequately?

Rosenhan & Seligman (1989) proposed some signs to determine whether someone is not coping:

• They no longer conform to standard interpersonal rules, such as maintaining eye contact & respecting personal space.
• They experience severe personal distress.
• Their behaviour becomes irrational or dangerous to themselves or others.

EG - INTELLECTUAL DISABILITY DISORDER

• Very low IQ (statistical deviation). However a diagnosis cannot be made on this basis only - an individual must also be failing to function adequately before a diagnosis would be given.

(+) Patient's perspective

• Attempts to include the subjective experience of the individual. It may not be an entirely satisfactory approach as it is difficult to assess distress, but at least this definition acknowledges that the experience of the patient is important.
• FTFA defininition captures the experience of many of the people who need help = useful for assessing abnormality.

(-) Is it simply a deviation from social norms?

• It's hard to say when someone is really failing to function & when they are just deviating from social norms.  We might think that not having a job/address is a sign of failure to function adequately, but some peoplw ith alternative lifestyles choose no to have those things.
• Also, those who practise extreme sports could be accused of behaving  in a maladaptive way, whilst those with religious/supernatural beliefs could be seen as irrational = limits personal freedom & discriminates against minority groups.

(-) Subjective judgements

• Someone has to judge whether a patient is distressed or distressing. Some patients may say they are distressed but may be judged as not suffering. There are methods for making such judgements as objective as possible, including checklists, such s the Global Assessment of Functioning scale. Someone still has the right to make this judgement.

--> Look at what makes anyone 'normal'.

--> Jahoda (1958) suggested we are in good mental health if we meet the following criteria:

• No symptoms of distress.
• Rational & can perceive ourselves accurately.
• We self-actualise (reach our potential)
• Can cope with stress.
• Have a realistic view of the world.
• Have good self-esteem and lack guilt.
• Independent of other people.
• We can successfully work, love & enjoy our leisure.

There is some overlap between what we might call deviation from ideal mental health and what we might call failure to function adequately.

We can think of someones inability to keep a job as either a failure to cope with the pressures of work or as a devation from the ideal of successfully working.

(+) It's a comprehensive definition

• It covers a broad range of criteria for mental health. In fact, it probably covers most of the reasons someone would seek help from mental health services or be referred for help.
• The big range of factors discussed in relation to J's ideal mental health make it a good tool.

(-) Cultural relativism

• Some ideas are specific to Western European & North American cultures (culture-bound).
• Eg - the emphasis on personal achievement (in self-actualisation) would be considered self-indulgent in much of the world due to emphasis on the individual instead of family/community.
• Much of the world would see independence from others as a bad thing = individualist cultures.

(-) It sets an unrealistically high standard for mental health

• Few of us attain all Jahoda's criteria for mental health, and probably none of us achieve them all at the same time/keep them up for very long = we're all abnormal?
• However it makes it clear to people the ways in which they could benefit from seeking treatment (eg - counselling) to improve their mental health.

All are characterised by: excessive fear and anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus.

DSM recognises the following categories of phobia & related anxiety disorder:

• Specific phobia: phobia of an object, such as an animal or body part, or a situation such as flying or having an injection.
• Social anxiety (social phobia): phobia of a social situation such as public speaking or using a public toilet.
• Agoraphobia: phobia of being outside or in a public place.

Fear responses in phobias are the same as we experience for any other fear even if the level of fear is irrational - out of proportion to the phobic stimulus.

PANIC

May panic in response to the presence of the phobic stimulus. May involve a rqange of behaviours including crying, screaming or running away.

AVOIDANCE

Unless the sufferer is making a conscious effort to face their fear, they tend to go to a lot of effort to avoid coming into contact with the phobic stimulus. This can make it hard to go about daily life. Eg - fear of public toilets, may limit time outside of home to how long they can last.

ENDURANCE

Alternative to avoidance. A sufferer remains in the presence of the phobic stimulus but continues to experience high levels of anxiety. This may be unavoidable in some situation, for example a person who has an extreme fear of flying.

ANXIETY

• Are anxiety disorders. Anxiety is an unpleasant state of high arousal. This prevents the suffer relaxing and makes it very difficult to experience any positive emotion.
• Anxiety can be long term. Fear is the immediate and extremely unpleasant response we experience when we encounter or think about the phobic stimulus.

EG - Arachnophobia

• Matt has a phobia of spiders. His anxiety levels will increase whenever he enters a place associated with spides - zoo or his garden shed. This anxiety is a general response to the situation. When he actually sees a spider he experiences fear - a very strong emotional response directed particularly towardst the spider itself.

EMOTIONAL RESPONSES ARE UNREASONABLE

• Go beyond reasonable. Eg - Matt's fear of spiders involves a very strong emotinoal response to a tiny, harmless spider = wildly disproportionate to the danger posed by any spider he will encounter.

--> Concerned with the ways in which people process information. People with phobias process information about phobic stimuli differently from other objects or situations.

SELECTIVE ATTENTION TO PHOBIC STIMULUS

If a sufferer can see the phobic stimulus it is hard to look away from it. Keeping our attention on something really dangerous is a good thing as it gives us the best chance or reacting quickly to a threat, but this is not so useful when the fear is irrational.

IRRATIONAL BELIEFS

For example, social phobias can involve beliefs like 'I must always sound intelligent' or 'if I blush people will think I'm weak'. This kind of belief increases the pressure on the sufferer to perform well in social situations.

COGNITIVE DISTORTIONS

The phobic's perceptions of the phobic stimulus may be distorted. For example, an omphalophobic is likely to see belly buttons as ugly/disgusting, and an ophidiophobic may see snakes as alien & aggressive looking.

--> All forms of depression & depressive disorders are characterised by changes to mood. The DSM recognises the following categories of depression and depressive disorders:

• Major depressive disorder:  severe but often short-term.
• Persistent depressive disorder:  long-term or recurring depression, including sustained major depression & dysthymia.
• Disruptive mood dysregulation disorder:  childhood temper tantrums.
• Premenstrual dysphoric disorder:  disruption to mood prior to and/or during menstruation.

ACTIVITY LEVELS

• Have reduced levels of energy - become lethargic. This has a knock-on effect, with sufferers tending to withdraw from work, education and social life, sometimes can't get out of bed.
• Depression may lead to opposite effect - psychomotor agitation. They struggle to relax and may end up pacing up and down a room.

DISRUPTION TO SLEEP & EATING BEHAVIOUR

• May experience insomnia, particularly premature waking, or more need to sleep (hypersomnia).
• Appitite may increase/decrease, leading to weight gain/loss.

AGGRESSION & SELF-HARM

• Often irritable, and in some cases they can become verbally or physically aggressive. This can have knock-on effects on a number of aspects of their life. Eg - a depressed person might display verbal aggresstion by ending a relationship/quitting a job.
• Aggression can also be at the self = self-harm, in the form of cutting, or suicide attempts.

LOWERED MOOD

• This is a defnining emotional element of depression but it is more pronounced than in the daily kind of experience of feeling lethargic and sad. Patients often describe themselves as 'worthless' and 'empty'.

ANGER

• Sometimes extreme anger
• Directed at the self or others.
• Sometimes, such emotions lead to aggressive or self-harming behaviour.

LOWERED SELF-ESTEEM

• Emotional experience of how much we like ourselves.
• Sufferers tend to report reduced self-esteem, and so like themselves less than usual.
• This can be quite extreme, with some sufferers of depression describing a sense of self-loathing.

--> Ways in which people process information. Depressed people tend to process information about several aspects of the world quite differently from the 'normal' ways that people without depression think.

POOR CONCENTRATION

• Unable to stick with a task as they usually would, or might find it hard to make decisions that they would normally find straightforward.
• Poor conc and poor decision making are likely to interfere with the individual's work.

ATTENDING TO AND DWELLING ON THE NEGATIVE

• Inclined to pay more attention to negative aspects of a situation and ignore the positives.
• Have bias towards recalling unhappy events rather than happy ones.

ABSOLUTIST THINKING

• Sufferers tend to think that most situations are either all-good or all-bad = 'black and white thinking'.  Therefore unfortunate situations are seen as a disaster.

--> DSM system recognises OCD and a range of related disorders. What these disorders all have in common is repetitive behaviour accompanied by obsessive thinking.

• OCD:  characterised by either obsessions (recurring thoughts, images, etc) and/or compulsions (repetitive behaviours such as hand washing). Most people with OCD have both.
• Trichotillomania:  compulsive hair pulling.
• Hoarding disorder:  the compulsive gathering of possessions and the inability to part with anything, regardless of its value.
• Excoration disorder:  compulsive skin picking.

COMPULSIONS - There are 2 elements to compulsive behaviours:

• Compulsions are repetitive: typically OCD sufferers feel compelled to repeat a behaviour. Common examples are hand washing, counting, praying, tidying/ordering objects.
• Compulsions reduce anxiety: around 10% of OCD sufferers show compulsive behaviour alone - have no obsessions, just a general sense of irrational anxiety. However, for the vast majority, compulsive behaviours are performed in an attempt to amnage the anxiety produced by obsessions. Eg - compulsive hand washing is carried out as a response to an obsessive fear of germs.

AVOIDANCE

• They avoid as an attempt to reduce anxiety by keeping away from situations that trigger it.
• Eg - sufferers who wash compulsively may avoid coming into contact with germs. However, this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish bins & this in itself can interfere with leading a normal life.

ANXIETY AND DISTRESS

• Regarded as a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming.
• Compulsions (urge to repeat a behaviour) create anxiety.

ACCOMPANYING DEPRESSION

• OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities. Compulsive behaviour tends to bring some relief from anxiety, but this is temporary.

GUILT AND DISGUST

• As well as anxiety and depression, OCD sometimes involves other negative emotions such as irrational guilt, such as over minor moral issues, or disgust, which may be directed against something external like dirt or at the self.

--> concerned witht he ways in which people process information. OCD sufferers are usually plagued with obsessive thoughts but adopt cognitive strategies to deal with them.

OBSESSIVE THOUGHTS

For 90%, the major cognitive feature of OCD is obsessive thoughts. They vary considerably from person to person but are always unpleasant. Could be worries of being contaminated by dirt or germs, or uncertainty that a door has been left unlocked.

COGNITIVE STRATEGIES TO DEAL WITH OBSESSIONS

Eg - a religious person tormented by obsessive guilt may respond by praying or mediating. This may help manage anxiety but can make the person appear abnromal to others & can distract them from everyday tasks.

INSIGHT INTO EXCESSIVE ANXIETY

• OCD sufferers are aware that their obsessions & compulsions are not rational - this is necessary for a diagnosis of OCD. If someone really believed that their obsessive thoughts were based on a reality that would be a symptom of a different mental disorder.
• However, OCD sufferers experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified. They also tend to be hypervigilant (ie maintain constant alertness & keep attention focused on potential hazards.

THE TWO-PROCESS MODEL

• The behavioural approac emphasises the role of learning in the acquisition of behaviour.
• The approach focuses on behaviour - what we can see.
• It is geared towards explaining the behavioural aspects of phobias (avoidance, endurance and panic) rather than the cognitive or emotional aspects of phobias.

--> Mowrer (1960) proposed the two-process model based on the behavioural approach to phobias.

--> This states that phobias are acquired (learned in the first place) by classical conditioning and then continue because of operant conditioning.

• Involves learning to associate something of which we initially have no fear (NS) which something that already triggers a fear response (UCS).
• Watson & Rayner (1920) - created a phobia in a 9-month-old baby, called 'Little Albert'.
• He showed no unusual anxiety at the start of the study. When shown a white rat he started to play with it.
• However, the experimenters then set out to give Albert a phobia. Whenever the rat was presented they made a loud noise by banging an iron bar close to Albert's ear.
• The noise is an UCS which creates an UCR of fear.
• When the rat (NS) and the UCS are encountered close together in time the NS becomes assoicated witht ht eUCS and both now produce the fear response - A became frightened when he saw a rat. The rat is now a CS that produces a CR.
• This conditioning then generalised to similar objects. They tested Albert by showing him other furry objects such as a non-white rabbit, a fur coat and Watson wearing a Santa Claus beard made out of cotton balls.
• Little A displayed distress as the sight of all of these.

• Reponses aquired by classical conditioning usually tend to decline over time. 
• However, phobias are often long lasting. Mowrer has explained this as the result of operant conditioning. 
• Operant conditioning takes place when our behaviour is reinforced or punished.
• Reinforcement tends to increase the frequency of a behaviour. This is true of both negative reinforcement (an individual avoids a situation that is unpleasant) and positive reinforcement = results in a desirable consequence, so the behaviour will be repeated.
• Mowrer suggested that whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that we would have suffered if we had remained there.
• This reduction in fear reinforces the avoidance behaviour and so the phobia is maintained. 

(+) Good explanatory power

It explains how phobias could be maintained over time & that this had important implications for therapies because it explains why patients need to be exposed to the feared stimulus. Once a patient is prevented from practising their avoidance behaviour, the behaviour ceases to be reuinforced & so declines = application to therapy.

(+) Alternative explanation for avoidance behaviour

Not all avoidance behaviour associated with phobias seems to be the result of anxiety reduction, at least in more complex phobias like agoraphobia. There is evidence to suggest that at least some avoidance behaviour appears to be motivated more by + feelings of safety. So the motivating factor in choosing an action like not leaving the house is to stick with the safety factor. This explains why some patients with agoraphobia are able to leave their house with a trusted person with relatively little anxiety but not alone (Buck, 2010) = avoidance is motivated by anxiety reduction.

(-) An incomplete explanation of phobias

• Bounton (2007) points out that evolutionary factors have an important role in phobias (2-factor theory does not mention this). Eg - we easily get phobias of things that have been a source of danger in evolutionary past, eg snakes = adaptive to acquire such fears. Seligman (1971) called this biological preparedness - innate predisposition to acquire certain fears.
• However, it is rare to develop a fear of cars or guns = are more dangerous. Presumably this is because they have only existed very recently = not biologically prepared - there is more to acquiring pohbias than simple conditioning. 

--> a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioing. If the sufferer can learn to relax in the presence of the phobic stimulus, they will be cured. A new response to to the phobic stimulus is learned (paired with relaxation instead of anxiety) = counterconditioning. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other = reciprocal inhibition:

• 1) The anxiety hierarchy is put together by the patient & therapist. Is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening. Eg - an arachnophobic might identify seeing a picture of a small spider as low on their anxiety hierarchy & holding a tarantula at the top of the hierarchy.
• 2) Relaxation - The therapist teaches the patient to relax as deeply as possible. This might involve breathing exercises or, alternatively, the patient might learn mental imagery techniques. Patients can be taught to imagine themselves in relaxing situations or they might learn meditation. Relaxation can also be achieved using drugs such as Valium.
• 3) Exposure - Patient is exposed to phobic stimulus while in a relaxed state. Takes place across several sessions, starting at bottom of the anxiety hierarchy. When patient can stay relaxed in the presence of the lower levels of the phobic stimulus they move up the hierarchy. Treatment is successful when the patient can stay relaxed in situations high on the anxiety hierarchy. 

(+) It is effective

• Gilroy et al (2003) followed up 42 patients who had been treated for spider phobia in 3 45-min sessions of SD. Agoraphobia was assessed on several measures inlcuding the Spider Questionnaire and by assessing response to a spider.
• A control group was treated by relaxation without exposure. At both 3 months & 33 months after the treatment the SD group were less fearful than the relaxation group = long lasting.

(+) It is suitable for a diverse range of patients

• Alternatives to SD (flooding & cognitive therapies) are not well suited to some patients. Eg - some sufferers of anxiety disorders like phobias also have learning difficulties - these make it very hard for some patients to understand what is happening during floording or to engage with cognitive therapies that require the ability to reflect on what you are thinking. 

(+) It is acceptable to patients

• Patients prefer it. People usually choose SD as it does not cause the same degree of trauma as flooding. It may also be because SD includes some elements (relaxation) that are pleasant = low refusal rates and low attrition rates (no. of patients dropping out of treatment) of SD.

--> Involves exposing phobic patients to their pohbic stimulus but without a gradual build-up in an anxiety hierarchy. Involves immediate exposure to a very frightening situation. Sessions are typically longer than SD sessions, one session often lasting 2-3 hours. Sometimes only one session is needed. 

HOW IT WORKS

• Flooding stops phobic responses very quickly. This is because, without the option of avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless.
• In classical conditioning terms this process is called extinction. A learned response is extinguished when the CS (eg a dog) is encountered without the UCS (eg being bitten). The result is that the CS no longer produces the CR (fear).
• Sometimes - patient may achieve relaxation in presence of phobic stimulus as they become exhausted by their own fear response. 
• ETHICAL SAFEGUARDS -->
• Not unethical but is an unpleasant experience so it is important that patients give fully informed consent to this traumatic procedure & that they are fully prepared before the flooding session. A patient is usually given the choice of SD or flooding.

(+) It's cost-effective

• Studies comparing flooding to cognitive therapies (Ougrin 2011) have found that flooding is highly effective quicker than alternatives. Quick effect is a strength because it means the patients are free of their symptoms as soon as possible = cheaper treatment. 

(-) It is less effective for some types of phobia

• Less effective for more complex phobias like social phobias. This may be because social phobias have cognitive aspects. Eg - a sufferer of a social phobia does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation. 
• This type of phobia may benefit more from cognitive therapies as such therapies tackle irrational thinking. 

(-) Treatment is traumatic for patients

• The problem is not that flooding is unethical (patients give consent) but that patients are often unwilling to see it through to the end. Limitation because time & money are sometimes wasted preparing students only to have them refuse to start/complete treatment. 

--> Beck (1967) suggested a cognitive approach to explaining why some people are more vulnerable to depression than others. It is a person's cognitions that create this vulnerability. He suggested 3 parts to this cognitive vulnerability: 

1) FAULTY INFORMATION PROCESSING

When depressed we attend to the negative aspects of a situation and ignore positives. For example, if I was depressed & won £1 million on the Lottery, I might focus on the fact that the previous week someone had won £10 million rather than focus on the positive of all I could do with £1 million. We also tend to blow small problems out of proportion and think in 'black and white' terms.

2) NEGATIVE SELF-SCHEMAS

• A schema is a 'package' of ideas & information developed through experience. They act as a mental framework for the interpretation of sensory information.
• A self-schema is package of information we have about ourselves. We use them to interpret the world, so if we have a - self-schema we interpret all info about ourselves in a - way. 

3) THE NEGATIVE TRIAD

A person develops a dysfunctional view of themselves because three types of negative thinking that occur automatically, regardless of the reality of what is happening at the time. These three elements are called the negative triad. When we are depressed, negative thoughts about the world, the future and oneself often come to us.

• Negative view of the world - an example would be 'the world is a cold hard place'. This creates the impression that there is no hope anywhere.
• Negative view of the future - an example would be 'there isn't much chance that the economy will really get better'. Such thoughts reduce any hopefulness and enhance depression. 
• Negative view of the self - an example would be 'I am a failure'. Such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem. 

• (+) It has good supporting evidence
• Supports idea that depression is associated with faulty information processing, negative self-schemas and the cognitive triad of negative automatic thinking.
• Eg - Grazioli & Terry (2000) assessed 65 pregnant women for cognitive vulnerability & depression before & after birth. Found = those women who were high in cognitive vulnerability were more likely to suffer post-natal depression.
• Eg - Clark & Beck (1999) reviewed research on this topic & concluded that there was solid support for all these cognitive vulnerability factors. Critically, these cognitions can be seen before depression develops, suggesting that Beck may be right about cognition causing depression, at least in some cases. 
• (+) It has a practical application in CBT
• Forms the basis of CBT. All cognitive aspects of depression can be identified & challenged in CBT. These include the components of the negative triad that are easily identifiable. This means a therapist can challenge them & encourage the patient to test whether they are true. Strength as translates will into a successful therapy.
• (-) It doesn't explain all aspects of depression
• Explains neatly the basic symptoms of depression, however depression is complex. Some depressed patients are deeply angry & Beck cannot easily explain this extreme emotion. Some depression sufferers have hallucinations & bizarre beliefs. Sometimes depressed patients suffer Cotard syndrome, the delusion that they are zombies (Jarret, 2013) - B's theory cannot easily explain these cases. 

--> Suggested a different cognitive explanation of depression. He proposed that good mental health is the result of rational thinking, defined as thinking in ways that allow people to be happy and free of pain. To Ellis, conditions like anxiety and depression result from irrational thoughts = any thoughts that interfere with us being happy and free of pain.

A - Activating event

Whereas Beck's emphasis was on automatic thoughts, Ellis focused on situations in which irrational thoughts are triggerered by external events. He said we get depressed when we experience negative events and these trigger irrational beliefs. Events like failing an important test or ending a relationship might trigger irrational beliefs.

B - Beliefs

He identified a range of irrational beliefs - he called the belief that we must always suceed or achieve perfection 'musturbation'. 'I-can't-stand-it-itis' is the belief that it is a major disaster whenever something does not go smoothly. Utopianism is the belief that like is always meant to be fair.

C - Consequences

When an activating event triggers irrational beliefs there are emotional and behavioural consequences. For example, if you believe you must always succeed and then fail at something this can trigger depression.

(+) It has a practical application in CBT

• Has led to successful therapy. The idea that, by challenging irrational negative belifs, a person can reduce their depression, is supported by research evidence (eg Lipsky et al, 1980). Suggests that the irrational beliefs had some role in the depression.

(-) A partial explanation

• Some cases of depression follow activating events. Psychologists call this reactive depression & see it as different from kind of depression that arises without obvious cause.
• = Ellis's explanation only applies to some kinds of depression & is therefore only a partial explanation. 

(-) It doesn't explain all aspects of depression

• Although Ellis explains why some people appear to be more vulnerable to depression than others due to their cognitions, his approach has very much the same limitations as Beck's. 
• It doesn't easily explain the anger associated with depression or the fact that some patients suffer hallucinations & delusions.

• CBT is the most commonly used psychological treatment for depression and a range of other mental health problems. Most common treatment for a mental health problem.
• Begins with an assessment in which the patient & the cognitive behaviour therapy put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.
• CBT then involves working to change negative & irrational thoughts and finally put more effective behaviours into place. 
• Some CBT therapists do this using techniques purely from Beck's cognitive therapy, or some rely exclusively on Ellis's rational emotive behaviour therapy. 

--> Application of Beck's cognitive theory of depression. The idea behind cognitive therapy is to identify automatic thoughts about the world, self & future (negative triad). Once identified, these thoughts must be challenged = central component in therapy.

--> As well as challenging these thoughts directly, cognitive therapy aims to help patients test the reality of their negative beliefs. They might therefore be set homework such as to record when they enjoyed an event or when people were nice to them. This is sometimes referred to as the 'patient as scientist', investigating the reality of their negative beliefs in the way a scientist would.

--> In future sessions if patients say that no one is nice to them or there is no point in going to events, the therapist can then produce this evidence and use it to prove the patient's statements are incorrect. 

• REBT extends the ABC model to an ABCDE model - D stands for dispute and E for effect.
• The central technique of REBT is to identify and dispute (challenge) irrational thoughts.  
• Eg - a patient might talk about how unlucky they have been or how unfair things seem.
• An REBT therapist would identify these examples of utopianism and challenge this as an irrational belief. This would involve a vigorous argument. 
• The intended effect is to change the irrational belief and so break the link between negative life events and depression.
• The vigorous argument is the hallmark of REBT. Ellis identified different methods of disputing. For example - empirical argument involves disputing whether there is actual evidence to support the negative belief. Logical argument involves disputing hether the negative thought logically follows from the facts. 

BEHAVIOURAL ACTIVATION

• Alongside the purely cognitive aspects of CBT the therapist may also work to encourage a depressed patient to be more active & engage in enjoyable activities.
• This behavioural activation will provide more evidence for the irrational nature of beliefs.

(+) It's effective

Eg - March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the 2 in 327 adolescents with a main diagnosis of depression. After 36 weeks, 81% of the CBT group, 81% of the antidepressants group & 86% of the CBT & antidepressants group were significantly improved. Thus CBT emerged as just as effective as medication & helpful alongside medication = good case for making CBT the 1st choice of treatment in systems like the NHS.

(-) CBT may not work for the most severe cases

• Some patients cannot motivate themselves to engage with the hard cognitive work of CBT and may not even be able to pay attention to what is happening in the session.
• When this is the case = possible to treat patients with antidepressant medication & start CBT when they're more alert & motivated = CBT cannot be used alone for all cases.

(-) Success may be due to the therapist-patient relationship

• Rosenzweig (1936) suggested that differences between methods of psychotherapy, such as between CBT & SD, might actually be quite small. All psychotherapies share one essential ingredient - the therapist-patient relationship. It may be  the quality of this relationship that determines success rather than any particular technique that is used.
• Comparative reviews (eg - Luborsky et al, 2002) find very small differences, which supports the view that simply having an opportunity to talk to someone who will listen matters most.

GENETIC EXPLANATIONS

• Some mental disorders, such as OCD, appear to have a stronger biological component than others.  One form of a biological explanation is the genetic explanation.
• Genes are involved in individual vulnerability to OCD.
• Lewis (1936) observed that of his OCD patients, 37% had OCD parents & 21% had siblings with OCD --> suggests it runs in families, although what is probably passed from one generation to the next is genetic vulnerability not the certainty of OCD.
• According to the diathesis-sress model, certain genes leave some people more likely to suffer a mental disorder but it is not certain - some environmental stress (experience) is necessary to trigger the condition.

CANDIDATE GENES

• Researchers have identified genes that create vulnerability for OCD = candidate genes.
• Some of these genes are involved in regulating the development of the serotonin system.
• Eg, the gene 5HT1-D beta helps the efficiency of transport of serotonin across synapses.

OCD IS POLYGENIC

• This means that OCD is not caused by one single gene, but that several genes are involved.
• Taylor (2013) analysed findings of previous studies and found evidence that up to 230 different genes may be involved in OCD.
• Genes that have beeen studied in relation to OCD include those associated with the action of dopamine & serotonin, both neurotransmitters which have a role in regulating mood.

DIFFERENT TYPES OF OCD

• Aetiologically heterogeneous - one group of genes may cause OCD in one person but a different group of genes may cause it in another. Different types of OCD may be the result of particular genetic variations, eg - hoarding disorder & religious obsession.

(+) Good supporting evidence

• From a variety of sources for the idea that some people are vulnerable to OCD due to their genetic make-up. One of best sources of evidence for importance of genes = twin studies.
• Nestadt et al (2010) - reviewed previous twin studies & found that 68% of identical twins shared OCD as opposed to 31% of non-identicals.

(-) Too many candidate genes

• Psychologists have been less successful at pinning down all the genes involved. One reason for this is because it appears that several genes are involved and that each genetic variation only increases the risk of OCD by a fraction.
• Genetic explanation = unlikely to ever be useful as it provides little predictive value.

(-) Environmental risk factors

• Cromer et al (2007) found that over half the OCD patients in their sample had a traumatic event in their past, and that OCD was more severe in those with more than one trauma.
• OCD = not entirely genetic in origin.

--> Genes associated with OCD = likely to affect levels of neurotransmitters & structures of the brain = neural explanations.

THE ROLE OF SEROTONIN

• Is believed to help regulate mood. Neurotransmitters are responsible for relaying information from one neuron to another.
• If a person has low levels of serotonin then normal transmission of mood-relevant information does not take place and mood is affected. Some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain.

DECISION-MAKING SYSTEMS

• Some cases,eg -  hoarding disorder, seem to be associated with impaired decision making. This may be associated with abnormal functioning on lateral (side) of frontal lobes of the brain. These are front part of the brain, responsible for logical thinking & decision making.
• Evidence to suggest the left parahippocampal gyrus, associated with processing unpleasant emotions, functions abnormally in OCD.

(+) There is some supporting evidence

• Evidence to support the role of some neural mechanisms in OCD. Eg - some antidepressants work purely on the serotonin system, increasing levels of this neurotransmitter. Such drugs are effective in reducing OCD symptoms = serotonin system is involved in OCD.
• Also, OCD symptoms form part of a no. of other biological origin conditions, eg - Parkinson's Disease (Nestasdt et al, 2010). Suggests biological processes that cause those symptoms may be responsible for OCD.

(-) It is not clear exactly what neural mechanisms are involved

Studies of decision making have shown that these neural systems are the same systems that function abnormally in OCD (Cavedini et al. 2002). However, research had identified other brain systems that may be involved sometimes but no system has been found that always plays a role in OCD = cannot really claim to understand neural mechanisms involved in OCD.

(-) We should not assume the neural mechanisms cause OCD

• Evidence to suggest that various neurotransmitters & structures of the brain do not function normally in patients with OCD.
• However, this is not the same as saying that this abnormal functioning causes OCD - these biological abnormalities could be a result of OCD rather than its cause.

Drug therapy for mental disorders aims to increase/decrease levels of neurotransmitters in the brain or to increase/decrease their activity. Low levels of serotonin = associated with OCD. Therefore, drugs work in various ways to increase the level of serotonin in the brain.

SSRIs

• Standard medical treatment used to tackle the symptoms of OCD = particular type of antidepressant drug called a selective serotonin reuptake inhibitor (SSRI).
• They work on the serotonin system in the brain. S is released by certain neurons in the brain, released by the presynaptic neurons & travel across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic to the postsynaptic neuron & then it is reabsorbed by the presynaptic where it is broken down & re-used.
• By preventing re-absorption & breakdown of serotonin, SSRIs effectively increase its levels in the synapse & so continue to stimulate the postsynaptic neuron --> compensates for whatever is wrong with the serotonin system in OCD.
• Dosage & other advice vary according to which SSRI is prescribed. A daily dose of Fluoxetine is 20mg but this may be increased if not beneficial to patient. The drug is available as capsules/liquid - takes 3-4 months of daily use for SSRIs to have impact on symptoms.

COMBINING SSRIs WITH OTHER TREATMENTS

Drugs are often used alongside CBT to treat OCD. The drugs reduce a patient's emotional symptoms, such as anxiety or depressed feelings. This means that patients can engage more effectively with CBT. Some people respond best to CBT alone whilst others benefit more form drugs like fluoexetine.

ALTERNATIVES TO SSRIs

When an SSRI isn't effective after 3-4 months the dose can be increased or it can be combined with other drugs. Sometimes different antidepressants are tried. Patients respond very differently to different drugs & alternatives work well for some but not at all for others.

• Tricyclics - are sometimes used, such as Clomipramine. These have the same effect on the serotonin system as SSRIs. It ahs more severe side-effects than SSRIs so is generally kept in reserve for patients who don't respond to SSRIs.
• SNRIs - These are, like Clomipramine, a second line of defence for patients who don't respond to SSRIs. SNRIs increase levels of serotonin as well as another different neutrotransmitter - noradrenaline.

(+) Effective at tackling OCD symptoms

• Soomro et al (2009) reviewed studies comparing SSRIs to placebos when treating OCD & concluded that all 17 studies showed better results for the SSRIs than placebos. Effectiveness is greatest when SSRIs are combined with psychological treatment (PT), usually CBT.
• Symptoms typically decline for around 70% of patients taking SSRIs, & for the 30%, drugs and/or CBT will be effective for some.  

(+) Cost-effective and non-disruptive

• Cheap. Using drugs is therefore good value for health systems like NHS. As compared to psychological therapies, SSRIs are also non-disruptive to patients' lives - you can simply take drugs until your symptoms decline & don't have to engage with hard work of PT.

(-) Can have side-effects

• Significant minority = no benefit. Some patients suffer indigestion, blurred vision & loss of sex drive (usually temporary)
• Those using Clomipramine, side-effects are more common & serious - >1 in 10 patients suffer erection problems, tremours & weight gain. >1 in 100 become aggressive & suffer disruption to blood pressure & heart rhythm.
• Reduces effectiveness because people stop taking the medication.

Statistical deviation – Occurs when an individual has a less common characteristic, for example being more depressed or less intelligent than most of the population.

Deviation from social norms – Concerns behaviour that is different from the accepted standards of behaviour in a community or society.

Failure to function adequately – occurs when someone is unable to cope with ordinary demands of day-to-day living.

Deviation from ideal mental health – Occurs when someone does not meet a set of criteria for good mental health.

Phobia – An irrational fear of an object or situation.

Depression – A mental disorder characterised by low mood & low energy levels.

OCD (Obsessive-compulsive disorder) – A condition characterised by obsessions and/or compulsive behaviour.

Behavioural – Ways in which people act.

Emotional – Ways in which people feel.

Cognitive – Ways in which people process information, including perception, attention and thinking.

Behavioural approach – A way of explaining behaviour in terms of what is observable and in terms of learning.

Classical conditioning – Learning by association. Occurs when 2 stimuli are repeatedly paired together – an unconditioned stimulus (UCS) and a new ‘neutral’ stimulus (NS). The NS eventually produces the same response that was first produced by the unlearned stimulus alone.

Operant conditioning – A form of learning in which behaviour is shaped and maintained by its consequences. Possible consequences of behaviour include positive reinforcement, negative reinforcement or punishment.

Systematic desensitisation (SD) – A behavioural therapy designed to reduce an unwanted response, such as anxiety, to a stimulus.  SD involves drawing up a hierarchy of anxiety-provoking situations related to the phobic stimulus, teaching the patient to relax, and then exposing them to phobic situations. The patient works their way through the hierarchy whilst maintaining relaxation.

Flooding – A behavioural therapy in which a phobic patient is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions.

Cognitive approach – Term ‘cognitive’ has come to mean ‘mental processes’, so this approach is focused on how our mental processes (eg – thoughts, perceptions, attention) affect behaviour.

Negative triad – Beck proposed that there were 3 kinds of negative thinking that contributed to becoming depressed: negative views of the world, the future and the self. Such negative views lead a person to interpret their experiences in a negative way and so make them more vulnerable to depression.

ABC model – Ellis proposed that depression occurs when an activating event (A) triggers an irrational belief (B) which is turn produces a consequence (C), ie – an emotional response like depression. The key to this process is the irrational belief.

Cognitive behaviour therapy (CBT) – a method for treating mental disorders based on both cognitive and behavioural techniques. From the cognitive viewpoint, the therapy aims to deal with thinking, such as challenging negative thoughts. The therapy also includes behavioural techniques such as behavioural activation.

Irrational thoughts – Also called dysfunctional thoughts. In Ellis’s model and therapy, these are defined as thoughts that are likely to interfere with a person’s happiness. Such dysfunctional thoughts lead to mental disorders such as depression.

Biological approach – A perspective that emphasises the importance of physical processes in the body such as genetic inheritance and neural function.

Genetic explanations – Genes make up chromosomes and consist of DNA which codes the physical features of an organism (such as eye colour, height) and psychological features (such as mental disorder, intelligence). Genes are transmitted from parents to offspring. (ie – inherited)

Neural explanations – The view that physical and psychological characteristics are determined by the behaviour of the nervous system, in particular the brain as well as individual neurons.

Drug therapy – Treatment involving drugs, ie – chemicals that have a particular effect on the functioning of the brain or some other body system. In the case of psychological disorders such drugs usually affect neurotransmitter levels.