Psychopathology Revision cards

Occurs when an individual has a less common (abnormal) characteristic e.g. being more depressed or less inteligent than most of the population. For example, the average IQ is 100 but 2% fall below 70 and would receive a diagnosis of mental retardation. 

Evaluation 

+ Real life application

All assessments of patients with mental health disorders involve some kind of measurement of how severe their symptoms are compared to statistical norms. Therefore, it is useful in clinical assessments. 

- Unusual characteristics can be positive 

IQ scores over 130 are just as abnormal as scores below 70 but super-intelligence isn't an undesirable characteristic that needs treatment. Just because a few people display a certain behaviour doesn't mean it's statistically abnormal and needs treatment. This means the concept of statistical deviation can't be used alone to make a diagnosis.

Concerns behaviour that is different from the accepted standards or behaviour in the community or society. Norms are specific to the culture we live in e.g. homosexuality is normal in most western countries but still is viewed as abnormal in some other cultures. We are making the social judgement that someone is abnormal because they don't conform to our moral standards. 

Evaluation 

+/- Not a sole explanation

A positive of it is it had real life application when diagnosing antisocial personality disorder. Therefore, there is use of it when diagnosing people as abnormal or normal. However, there are often other factors to consider for example, when diagnosing antisocial personality disorder, the failure to function definition also well defines to disorder. So, in practise, deviation from social norms is not the sole reason for defining abnormality. 

- Social norms vary from one generation to another and from community to another. This means a person from one cultural group may label someone from another cultural as behaving abnormally according to their standards rather than the standards of the person. E.g. hearing voices is socially acceptable in some cultures but would be a sign of psychological disorders in the UK. 

Occurs when someone is unable to cope with the ordinary demands of day to day living. Rosenhan and Seligman proposed signs when someone isn't coping: when a person no longer conforms to standard interpersonal rules, when a person experiences severe personal distress and when a person's behaviour becomes irrational or dangerous. 

Evaluation

+ Patient's perspective 

This definition includes subjective experiences of the individual. It is difficult to assess distress, but at least this definition acknowledges that experience of the patient is important. This means it captures the experience of many people who need help

- Subjective judgements 

When deciding if someone is failing to function adequately, someone is judging whether a patient is suffering or not. There are methods for making judgements more objective e.g. checklists but the principle remains that someone has the right to make that judgement. 

Occurs when someone doesn't meet a set of criteria for good mental health. Marie Jahoda suggested we meet these criteria we will be mentally healthy: no symptoms of distress, rational perceive others accurately, cope with stress, good self-esteem, lack guilt, independent of others and we can successfully work, love and enjoy leisure. 

Evaluation

+ Comprehensive definition

It covers a broad range of criteria for mental health and probably covers most of the reasons someone would seek help from mental health services. The sheer range of factors make it a good tool for thinking about mental health.

- Unrealistically high standards for mental health

Very few people attain Jahoda's criteria for mental health and probably none of us will achieve all of them at the same time. Therefore, this approach would identify all of us as abnormal. 

Phobia - an irrational fear of an object or situation. 

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

Types of phobia:

1) Specific - phobia of an object e.g. animals or needles

2) Social anxiety - phobia of social situations e.g. public speaking or using public toilets

3) Agoraphobia - phobia of being outside or in a public place e.g. crowds

Panic

Crying, screaming or running away. Children may freeze, cling to a parent or have a tantrum. 

Avoidance

Making a conscious effort to avoid coming into contact with the phobic stimulus. This can make it daily life hard and can interfere with work, education and social life. 

Endurance

A sufferer remains in the presence of the phobia and experienced high levels of anxiety. This may be because the stimulus is unavoidable. 

Anxiety 

Phobias are classified as anxiety disorders. They involve an emotional response of anxiety which is an unpleasant state of high arousal that prevents the sufferer from relaxing and having positive emotions. Anxiety can last a long time, but fear is immediate and unpleasant response we experience when we encounter the phobic stimuli. 

For example, with arachnophobia (spiders) his anxiety levels increase when he enters a place associated with spiders e.g. shed or dusty house. This anxiety is a general response to the situation but when he actually sees the spider, he experiences fear. 

Unreasonable emotional response

The response to the phobic stimuli is widely disproportionate and unreasonable to the threat posed. E.g. an arachnophobia will have a strong emotional response to a tiny spider.

Selective attention to phobic stimulus

If you can see the phobic stimulus you can't look away. Keeping attention on it means we can react quicker to threat e.g. someone with pogonophobia (fear of beards) cannot concentrate on a task if there is a bearded man in the room.

Irrational beliefs

A phobic may hold irrational beliefs in the phobic stimulus. This may be the cause of unreasonable responses of anxiety towards the phobic stimulus, due to the patient’s incorrect perception as to what the danger posed actually is.

Cognitive distortions

The patient does not perceive the phobic stimulus accurately. Therefore, it may often appear grossly distorted or irrational e.g. mycophobia (a phobia of mushrooms). 

Mowrer (1960) proposed the two-process model where phobias are learnt by classical conditioning and then maintained by operant conditioning. 

Little Albert 

Watson and Rayner (1920) created a phobia in a 9-month-old baby called 'Little Albert'. When Albert played with a little white rat they then presented a loud bang by hitting an iron bar close to Alberts' ear each time the rat was shown to him. This caused him to be distressed with fear. Over time this continued and Albert demonstrated a response of fear when presented with the rat. The conditioning caused him to fear other objects like Santa's beard or white rabbits. 

The loud noise was the UCS, Alberts' response (crying) was the UCR and the rat was the NS. After the third trial, whenever the rat (CS) was present, Albert showed fear (CR). 

Negative reinforcement maintains a phobia as patients with a phobia will avoid the phobic stimulus to escape the fear and anxiety we would have suffered. This reduction in fear reinforces the avoidance behaviour so the phobia is maintained. 

+ Good explanatory power

The model was a good step forward for Watson and Rayner's concept that phobias are acquired through classical conditioning. It explains how phobias are maintained which helps when treating phobias because is explains why patients need to be exposed to their feared stimulus to help them see that nothing bad will happen when confronted with the stimulus.  

- Incomplete explanation 

Bouton points out evolutionary factors have an important role, for example, we easily develop phobias for things that would have been dangerous in the past such as snakes, tarantulas or the dark. Seligman called this biological preparedness - we are predetermined to fear certain things. However, it is rare to develop a fear of guns or cars which are more dangerous nowadays but this may be because they have only existed recently so we are not biologically prepared to fear them. 

- Avoidant behaviour explanation

Not all avoidant behaviour is a result of anxiety. A person with a fear of open spaces may choose to stay inside not to avoid the stimulus but to feel safe and some people are able to leave the house with a trusted person. This is a problem with the two process model which suggests avoidance is motivated by anxiety reduction.  

A behavioural therapy designed to reduce phobic anxiety through classical conditioning and training the sufferer to relax instead of feeling anxious. Counterconditioning - Learning a new response to a stimulus. Reciprocal inhibition - it is impossible to be afraid and relaxed at the same time so one emotion prevents the other. 

Process of SD

1) Anxiety hierarchy - An ordered list of related situations to the phobic stimulus that provokes anxiety. E.g. someone with a fear of cats may have a list like saying the word cat, holding a picture if a cat and walking down the street near a cat. 

2) Relaxation - Teach the patient to relax through breathing exercises, imagery techniques and medication. 

3) Exposure - Starting at the bottom of the hierarchy list, you gradually expose the phobic stimulus to the patient while they are relaxed. This takes place over several sessions and continues until the patient can stay relaxed in the presence of the lower anxiety stimulus. Next, they move up the hierarchy and treatment is successful when they can stay relaxed in situations high on the anxiety hierarchy. 

+ Suitable for a diverse range of patients

Can be used on a variety of people including those with learning difficulties who may struggle to understand what is going on during flooding or cognitive therapy.

+ Effective

Gilroy et al (2003) followed up 42 patients being treated for arachnophobia in three 45 minute sessions od SD. They were assessed on several measures including a spider questionnaire and assessing the response to a spider. A control group was treated with relaxation with no exposure. At 3 months and 33 months, the SD group were less fearful than the relaxation group which shows how helpful and effective it is long term. 

- Treats the symptoms, not the causes) of the phobia

SD only treats the observable and measurable symptoms of a phobia. This is a significant weakness because cognitions and emotions are often the motivators of behaviour and so the treatment is only dealing with symptoms, not the underlying causes.

This involves exposing phobia patients to a phobic stimulus but without gradual build up. Sessions are typically longer than SD sessions with one session lasting 2-3 hours. 

Without the option of avoidance, the patient quickly learns that the phobic stimulus is harmless and so this can cure phobias quickly. In classical conditioning, this term is called extinction. A learned response is extinguished when you can face the conditioned stimulus without having the unconditioned response.  

Some ethical issues need to be considered, for example, its important the patients give full informed consent as it is a traumatic experience. A patient would be given a choice of either systematic desensitisation or flooding. 

- Traumatic

High trauma is not unethical but patients are often unwilling to see the treatment through to the end. Time and money may be wasted preparing patients in the meantime.

- Less effective for some phobias

Flooding may be less effective for more complex phobias like social phobias. This may be because they involve cognitive aspects e.g. a sufferer doesn't simply experience anxiety but also unpleasant thoughts about the social situation. This type of phobia may benefit from cognitive therapies to tackle the irrational thinking. 

+ Cost effective

Studies comparing flooding to cognitive therapies found flooding is highly effective and quicker. This is a strength because patients are free of their symptoms as soon as possible and that makes the treatment cheaper.

Activity levels

Patients have reduced levels of energy making them lethargic. This means sufferers tend to withdraw from work, education and social life and some can't get out of bed. However, it may lead to psychomotor agitation - agitated people struggle to relax and may pace up and down the room. 

Disruption to sleep and eating behaviour

Sufferers may experience reduced sleep (insomnia), particularly premature waking or an increased need for sleep. Similarly, appetite and eating may increase or decrease leading to a change in weight.  

Aggression and self-harm

Sufferers are often irritable and may become verbally or physically aggressive. This may be shown by patients ending a relationship or quitting a job. Physical aggression can be directed to yourself; this included self-harm e.g. cutting or suicide. 

Lowered mood

Patients feel sad, they often describe themselves as worthless and empty. There is more to depression than feeling sad, however.

Anger

Patients feel more negative emotions causing them to feel angry at themselves or others. This can lead to aggression or self-harming behaviour. 

Lowered self-esteem

This can be extreme with some patients describing a sense of self-loathing like hating themselves. 

Poor concentration

Sufferers may find themselves unable to stick with a task as they usually would or they may find it hard to make decisions that would normally be easy. 

Attending to and dwelling on the negative

Sufferers pay more attention to the negatives and ignore the positives. They also have a bias towards recalling unhappy events. 

Absolutist thinking

They think situations are either all bad or all good. They see unfortunate situations as an absolute disaster.  

Beck's cognitive theory of depression

Negative triad- We have negative views about:

1) The self e.g. 'I am worthless'

2) The future e.g. 'I will never be good at anything'

3) The world e.g. 'the world is a cold hard place' 

Negative self-schemas - we interpret all the information about ourselves in a negative way. This may be due to childhood events such as a loss of a parent, rejection of peers, criticism by teachers or parents, physical abuse and emotional abuse. 

Faulty information processing - when depressed we attend to the negative aspects of a situation and ignore the positives. We also tend to blow small problems out of proportion and think in 'black and white' terms.

+ Good supporting evidence

Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. They found that those women judged to have been high in cognitive vulnerability were more likely to suffer postnatal depression. Clark and Beck also agreed that there is solid support for all these cognitive vulnerability factors. These cognitions can be seen before depression develops suggesting Beck may be right. 

+ Practical application in CBT

Beck's Theory forms the basis of CBT. All cognitive aspects of depression, including the negative triad, can be identified and challenged by CBT. The patients will encourage patients to test whether they are true. 

- Doesn't explain all aspects of depression 

Beck's theory only explains the basic symptoms of depression however depression is complex. Some patients are deeply angry and Beck can't easily explain this extreme emotion. Some sufferers also have hallucinations and bizarre beliefs which Beck's theory can't explain. 

Ellis (1962) suggested depression is a result of irrational thoughts. He then defined irrational thoughts as any thoughts that interfere with us being happy. The ABC model is used to explain how irrational thoughts affect our behaviour and emotional state. 

A - Activating event 

We get depressed when we experience negative events that trigger irrational beliefs e.g. failing an important test may trigger irrational beliefs. 

B - Beliefs 

The belief or explanation about why the situation occurred may become irrational e.g. 'I failed the test because I'm worthless and a failure'.

C - Consequences

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

+ Practical application in CBT 

Like Beck's explanation, it has led to successful therapy. By challenging irrational beliefs a person can reduce their depression. This supports the basic theory as it suggests irrational beliefs have some role in depression. 

- Doesn't explain all aspects of depression 

Whilst the explanations does explain why some people appear to be more vulnerable as a result of their cognitions, the approach has the same limitations as Beck's. It doesn't explain the anger associated with depression or that some patients suffer hallucinations and delusions. 

- Partial explanation

There is no doubt some cases of depression follow an activating event, this is known as reactive depression. But Ellis's explanation only applies to some kinds of depression and is therefore only a partial explanation for depression. 

CBT begins with an assessment where patients and their therapists work together to clarify the patient's problems. They identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts and then challenge those beliefs. 

Beck's cognitive therapy

Therapist help clients identify negative thoughts by keeping a diary. They then challenge the dysfunctional cognitions by drawing on positive incidents. The therapist may set homework e.g. if someone says no one likes them then their homework could be to count how many people smile at them. This shows the pateint how negative thoughts are irrational and unrealistic. Small goals are set to encourage a sense of personal achievement e.g. getting out of bed

Ellis's rational emotive behaviour therapy (REBT) 

ABCDE model where D stands for dispute and E for effect. The central technique for REBT is to identify and challenge irrational thoughts. Logical disputing involves challenging whether the negative thought logically follows from the facts. Empirical disputing involves challenging whether there is actual evidence to support the negative belief. Pragmatic disputing emphasises the lack of usefulness of self-defeating beliefs. 

Behavioural activation - Alongside CBT, the therapist may also encourage a patient to be more active and take part in enjoyable activities. 

+ Effective 

David et al. (2008) found, using 170 patients suffering from depression, that patients treated with 14 weeks of REBT had better treatment outcomes than those treated with the drug fluoxetine when checked 6 months after treatment. This suggests REBT is more effective and long term than drug therapy. 

- May not work for severe cases

For some pateints, their depression may be so severe that they can't motivate themselves to engage in CBT or they may not be able to pay attention to what is happening in sessions. In this case, antidepressants may be more effective in treating depression. This means CBT can't be used as the sole treatment for all cases of depression. 

- Therapist-patient relationship 

Rosenzweig (1936) suggested the success of the therapy may be due to the quality of the relationship built between the therapist and the patient. This suggests simply having an opportunity to talk to someone who will listen could be what matters most. 

+ Occurs over short periods of time, cost-effective and has long term benefits as the techniques are designed to stop symptoms returning. 

Obsessive-compulsive disorder (OCD) is a condition characterised by obsessions and compulsions. 

The OCD cycle

Compulsions are repetitive

Sufferers typically feel compelled to repeat a behaviour e.g. hand washing

Compulsions reduce anxiety

10% of suffers show compulsive behaviour alone with no obsessions. However, for the majority, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions e.g. compulsive hand washing is carried out as a response to an obsessive fear of germs. 

Avoidance 

OCD sufferers may try to reduce anxiety by keeping away from the situations that trigger it e.g. coming into contact with germs. This can lead to avoiding everyday situations. 

Anxiety and distress

The urge to repeat a compulsion creates anxiety. OCD is regarded as an unpleasant emotional experience because of the powerful anxiety. Obsessive thoughts are unpleasant and frightening and the anxiety can be overwhelming. 

Accompanying depression

OCB is often accompanied by depression. This creates anxiety, low moods and lack of enjoyment in activities. The compulsive behaviour only brings temporary relief. 

Guilt and disgust

OCD sometimes involves other negative emotions e.g. irrational guilt over potentially minor issues or disgust which may be directed at external things like dirt and at the self.

Obsessive thoughts

For 90% of sufferers, the main cognitive feature is obsessive thoughts. These vary from person to person. An example is being worried a door was left unlocked.

Cognitive strategies to deal with obsessions

People may adopt cognitive coping strategies to deal with obsessions e.g. a religious person tormented by obsessive guilt may pray. While this may help manage the anxiety, it may make the person seem abnormal to others and could distract them from everyday life. 

Insight into excessive anxiety 

Sufferers are aware that their obsession and compulsions aren't rational. If someone really believed their obsessive thoughts were based on reality that would be another mental disorder. OCD sufferers experience catastrophic thoughts about the worst case scenario. They also tend to be hypervigilant.  

Lewis (1936) observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD. This suggests that OCD has a biological component. According to the diathesis-stress model, certain genes leave some people more likely to suffer a mental disorder but some environmental stress is necessary to trigger the condition. 

COMT gene regulates dopamine. High levels of dopamine are more common in patients with OCD. 

SERT gene (5-HTT) gene regulates serotonin. Low levels of serotonin are associated with OCD. 

OCD may be polygenic which means more than one gene contributes to OCD.  

+ Supporting evidence

Nestadt et al (2010) reviewed previous twin studies and found 68% of MZ twins shared OCD as opposed to 31% of DZ twins. Also, Ozaki et al (2003) found two unrelated families with a mutation in the SERT gene and 6 out of 7 family members had OCD. This strongly suggests a genetic influence on OCD and that low levels of serotonin can lead to OCD. 

- Too many candidate genes

Psychologists have been less successful at pinning down all the genes involved with OCD. The genes may only increase the chance of OCD by a tiny fraction. This suggests the explanation is unlikely to be useful as it has little predictive value. 

- Environmental risk factors

Environmental factors can increase the risk of OCD. Cromer et al (2007) found that over half of the OCD patients had a traumatic event in their past and that OCD was more severe in those with more than one trauma. This suggests that OCD cannot be entirely genetic. 

Lateral frontal lobes - Responsible for logical thinking and decision making. Abnormal functioning of this area is associated with hoarding disorder. 

Basal ganglia - Coordinates movement. Hypersensitivity due to brain injuries in this area may result in repetitive movements and OCD like symptoms. 

Orbital frontal cortex - Converts sensory information into thoughts and actions. Excessive activity in this area increases sensory information to actions which cause compulsions and prevents patients from stopping. 

Left parahippocampal gyrus - Associated with processing unpleasant emotions. OCD is likely to occur when this area functions abnormally. 

+ Supportive evidence 

Empirical evidence supports neural explanations and the data gathered from the experiments is quantitative as they use precise measurements such as brain scans. 

- Not clear what neural mechanisms are involved

Studies of decision making have shown that these neural systems are the same systems that function abnormally in OCD. However, research had also identified other brain systems that may be involved sometimes but no system had been found that always plays a role in OCD. 

- Neural mechanisms may not cause OCD

There is evidence to suggest that various neurotransmitters are structures of the brain do not function normally in patients with OCD. However, this is not the same as saying they cause OCD. These biological abnormalities could be a result of OCD rather than its cause. 

SSRI's - Selective serotonin reuptake inhibitor. This antidepressant drug works on the serotonin system in the brain. Serotonin is released by the presynaptic neuron and travels across a synapse to the postsynaptic neuron where it is then absorbed. Any leftover serotonin is then reabsorbed back into the presynaptic neuron and is broken down and reused. SSRI's prevent the reabsorption and breakdown of serotonin. This means there is an increased level of serotonin in the synapse which then continues to stimulate the postsynaptic neuron. A typical dosage would be 20mg. 

Combining SSRI's with other treatments - Drugs are often used alongside CBT. The drugs reduce the patient's emotional symptoms such as feeling anxious. This means patients can engage more effectively with CBT. 

Alternatives to SSRI's - Tricyclics are used and have the same effect on serotonin systems as SSRI's. They do have more severe side effects than SSRI's so are generally for patients who don't respond to SSRI's. SNRI's are like a second line of defence for patients who don't respond to SSRI's. SNRI's increase levels of serotonin as well as noradrenaline another neurotransmitter. 

+ Effective

Soomro et al (2009) compared SSRI's to placebos and concluded that all 17 students showed significantly better results for the SSRI's than a placebo. Effectiveness is greater when SSRI's are combined with CBT. Typically symptoms decline for around 70% of patients when using SSRI's so drugs can help most patients with OCD. 

+ Cost effective and non-disruptive

Drug treatments are cheap compared to psychological treatments. Using drugs is, therefore, good value for public health systems like the NHS. SSRI's are also less disruptive to a patients life than therapy. You can take drugs until your symptoms decline and not engage with the hard work of psychological therapy. 

- Side effects

SSRI's have side effects such as indigestion, blurred vision and loss of sex drive. These are usually temporary. Tricyclics have more severe side effects. More than 1 in 10 males suffer from erection problems and many people suffer from tremors, weight gain, aggression and disruption in blood pressure. These side effects reduce the effectiveness of the medication as people may stop taking them.