Psychopathology Year 12 Mock revision

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  • Created on: 01-06-19 12:58

Abnormality: Deviation From Social Norms

a psychological or behavioural state leading to impairment of interpersonal functioning and/or distress to others.

Social norms - unwritten rules for acceptable behaviour in a society. Anyone who deviates from these social norms can be deemed abnormal. 

STRENGTHS:

  • Helps people - the fact that society can intervene in abnormal people's life can be beneficial as such individuals may not be able to help themselves. 
  • Protects society - definition seeks to protect people from the effects an abnormal individual's behaviour can have on others. 

WEAKNESSES:

  • Cultural differences - definition is limited by cultural and historical relativism. What is socially acceptable behaviour is different by culture and changes all the time e.g. homosexuality was seen as deviant. 
  • Individualism - those who do not adhere to social norms may not be abnormal but simply individualistic and not problematic in any way. 
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Abnormality: Failure To Function Adequately

when individuals cannot cope with everyday life and distress interferes with work, relationships and looking after themselves they can be considered abnormal. 

STRENGTHS:

  • Matches sufferer's perception - as most people seeking clinical help believe that they are suffering from psychological problems that interfere with their ability to function properly, it supports the definition. 
  • Assesses degree of abnomality - the GAF scale allows clinicians to see the degree to which individuals are abnormal and thus decide who needs psychiatric help. 

WEAKNESSES:

  • Normal abnormality - certain behaviours may be logical responses to situations e.g. feeling depressed after death of loved one is a normal response so long as it doesn't continue excessively. The definition does not consider this. 
  • Abnormality is not always accompanied by a failure to function adequately - psychopaths such as Harold Shipman was abnormal but did remained a functional doctor. 

 


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Abnormality: Deviation From Ideal Mental Health

when an individual fails to meet the criteria for ideal psychological wellbeing (e.g. positive attitudes to the self or resistance to stress) this could mean a person is abnormal. 

STRENGTHS:

  • Positivity - definition is a positive approach to mental health by focusing on what is desirable rather than undesirable. 
  • Target areas of dysfunction - definition allows targeting of certain areas to work on when treating abnormality. Allows focus on specific problems within a disorder. 

WEAKNESSES:

  • Over-demanding critieria - most people do not fill Jahoda's criteria all the time. This definition is thus flawed because it implies we are all abnormal at times. 
  • Cultural and historical differences - definition is limited by cultural and historical relativism. What is ideal mental health is different by culture and changes all the time. Homosexuality was considered a mental disorder, for example. 

 

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Abnormality: Statistical Infrequency

any behaviours that fall out of statistically frequent norm in society can be considered abnormal. 

STRENGTHS:

  • Overall view - this definition gives an overview of what behaviours and characteristics are infrequent in a given population
  • Evidence for assistance - statistical evidence that a person has a mental disorder can be used to justify requests for psychiatric assistance

WEAKNESSES: 

  • Not all infrequent behaviours are abnormal - this definition fails to distinguish between statistically infrequent behaviours that are undesirable and desirable. Definition should focus on infrequent and undesirable behaviours which require treatment. 
  • Where to draw the line - no way of defining the extent to which an individual must deviate from statistically infrequent behaviours to be defined as abnormal. The cut-off point at which a behaviour is judged to be abnormal is subjective. 
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Phobias

anxiety disorders characterised by extreme, irrational fears of a stimulus/situation e.g. arachnophobia

  • Behavioural - avoidant response 
  • Emotional - persistent, excessive fear 
  • Cognitive - recognition of exaggerated anxiety

BEHAVIOURIST EXPLANATION

  • Phobias are acquired through classical conditioning (learnt through experience via association) or social learning theory (learnt through observation and imitation of a model)
  • Watson classically conditioned Little Albert to develop a fear of white rats and objects like it. Supports the two-process model in explaining acquisition of phobias. 
  • Phobias are maintained by operant conditioning (avoidance response to phobic stimuli is rewarding as it keeps anxiety away - negative reinforcement and thus is repeated, maintaining the phobia)
  • Di Gallo found that car phobics tended to make avoidance responses involving staying at home rather than making car joruneys to see friends which can be explained by operant conditioning. Avoidance response = rewarding as it avoided fear response (negative reinforcement). Supports the two-process model in explaining maintenance of phobias

     

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Phobias Explanation Evaluation

Behavioural explanation of phobias ignores the role of other factors e.g. genetic predisposition and cognitions in the acquisition and treatment of phobias, and thus is a reductionist theory. Snake phobics overestimated number of snakes in an image compared to control group - shows the role maladaptive thinking (cognitive element) plays in acquisition of phobias that behaviourist explanation fails to acknowledge.

Evolutionary explanation - phobias may be inherited because of adaptive value e.g. helps to avoid and escape potentially dangerous situations. Makes sense as most common phobias e.g. darkness, snakes, spiders, heights are potentially dangerous. Seligman found that rats could be easily conditioned to avoid life-threatening stimuli such as toxic liquids (found in nature) but could not be easily conditioned to avoid non-harmful stimuli such as flashing lights (not found in nature). This alternative explanation backed by research reduces support for the behavioural explanation in that it seems to suggest most phobias are innate, rather than learnt via classical conditioning or social learning theory. 

The effectiveness of behaviourist treatments like systematic desensitisation in addressing phobic symptoms, lends support to the behaviourist explanations of phobias. 

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Phobias Treatment - SD

SYSTEMATIC DESENSITISATION

  • behavioural therapy where phobic learns relaxation techniques and then faces progressive escalating exposure to the phobic stimuli/situation

based on the behaviourist principle of classical conditioning - aims to unlearn the negative stimulus-response association between phobic stimuli and fear, by replacing fear with relaxation. 

Client + therapist construct fear hierarchy - progressive escalating exposure to phobic stimuli ranging from minor fear that causes discomfort to major fear causing suffering. A snake phobic ranges from watching a video of snake to holding one. 

Contact is real-life (vivo) or by imagination (vitro). Client is taught relaxation techniques for each stage of fear hierarchy, then exposed to phobic stimuli, till it becomes associated with feelings of relaxation rather than anxiety - and they lose their phobia. 

Based on the concept of reciprocal inhibition - it is impossible for the two emotions of anxiety and relaxation to co-exist. One must take over.

 

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Phobias Treatment - FLOODING

  • behavioural therapy used to remove phobias through direct confrontation to phobic stimuli. 

contact = immediate and full on e.g. claustrophobe being forced into enclosed space for long time. 

Client is unable to carry out usual avoidance response

therefore, anxiety and adrenaline levels will peak so high that they cannot be maintained for long

so will eventually subside

leading to extinction - where feared stimuli (conditioned stimulus) that produced anxiety (conditioned response) becomes a neutral stimulus, producing no response. 

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Phobias Treatment Evaluation

Research evidence to support behaviourist treatment of phobias - Capafons found that aerophobics that had undergone SD, independently reported lower levels of fear and anxiety and actually showed lower levels of physiological arousal compared to a control group when subjected to flight simulation  Wolpe found that when a car phobic was subjected to flooding (being driven around in a car for hours), her anxiety had been eradicated. The success rates shown by the study and case study evidence are indicative of behaviourist therapies towards phobias being effective and so, gives support to them

Behavioural therapies require less effort on client's behalf than psychotherapies like CBT where patients must play a more active part and fully engage in their treatment. SD and flooding do not require this level of intellectual engagement so could be seen as more universally accessible forms of treatments for phobics as well as achieving successful outcomes quicker than psychotherapies. This would then bolster behavioural treatments as more suitable for phobias than others.

Behavioural therapies address observable symptoms - treatment not as long-lasting if anxiety is much deeper rooted psychological problem. Phenomenon such as symptom substitution, due to cognitions surrounding phobias being left unaddressed, weakens support for efficacy of behavioural treatments. CBT targets maladaptive thinking that underpins phobias so has shown to be a more effective treatment than behavioural therapies (most frequent used)

 

 

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Depression

mood disorder characterised by feelings of despondency and hopelessness

Unipolar depression - depression without mania

characterised by:

  • Behavioural - loss of energy, loss of appetite, social withdrawal
  • Emotional - constant depressed mood, loss of enthusiasm and motivation
  • Cognitive - pessimism, reduced concentration

Bipolar depression - form of depression characterised by periods of despondency and hopelessness and periods of elevated moods

characterised by:

  • Behavioural - high energy levels, recklessness, increased social interactions
  • Emotional - elevated mood states, intense euphoria, irritability
  • Cognitive - delusions, irrational thoughts
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Depression Explanation

Cognitive explanation of depression focuses on maladaptive thinking that underpins depression e.g. irrational, illogical and distorted views of onself, the world and future. Depressive may automatically think of themselves in a pessimistic and unrealistic way 

BECK'S NEGATIVE TRIAD:

model of cognitive biases that characterise depression including negative thoughts about the self, world and future. 

Beck argues that depression occurs when an individual sees life through a negative schema that dominates thinking - e.g. a self blame schema makes a depressive feel personally responsible for all misfortunes. This combined with cognitive biases that distort reality e.g. overgeneralisation upkeep negative triad. 

ELLIS' ABC MODEL:

explanation that sees depression through activating event, belief and consequence. Ellis believes that depressives faulty interpretations of external events is responsible for their distress. Use bad grade example. 

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Depression Explanation Evaluation

Research evidence supporting cognitive vulnerability to onset of depression - Boury found that student depressives misinterpret facts and experiences in a negative fashion and feel hopeless about future, suggesting that this is a result of maladaptive cognitive biases and negative schemas, supporting Beck's model. 

The biological explanation suggests there is an inherited predisposition to depression. Polim found that genetics accounted for 66% of cognitive abilities, suggesting that cognitive features of depression may have a genetic component to them. However, if the genetic cause was solely true, concordance rates in MZ twins should be 100% which has not been reported. This means that cognitive factors as well as genetics both play a role when explaining depression. 

Cognitive explanation of depression is based upon scientific principles that can be objectively tested - allowing improvements of model and understanding of disorder. 

Cognitive approach has had less success in explaining and treating mania in bipolar depression, which lessens support for the model as a universal explanation of depression. 

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Depression Treatment

CBT is based on the assumption that if we alter maladaptive thinking this will result in a reduction of depressive behavioural and emotional symptoms and bring positive change to patient. 

REBT - Rational Emotional Behavioural Therapy 

Educational phase - therapist aims to challenge clients' automatic, negative, irrational thinking and encourage more positive, rational cognitions regarding themselves, world and future. 

Client is asked to examine the cognitions that underpin set of beliefs which therapist goes onto expose as negatively maladaptive through logical and pragmatic disputing. They then encourage more positive thinking where ABC model is reintrepreted rationally so clients become more realistic. 

Pleasant event scheduling follows - therapist aims to increase clients' participation in rewarding activities. Therapist may ask them to record their thoughts during and test whether positive thinking led to more positive emotions and behaviours. This hypothesis testing acts as a form of positve reinforcement, so rewarding activites becomes pleasurable and more likely to be repeated. Cycle of rewards should decrease depressive symptoms. 

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Depression Treatment Evaluation

CBT seems to be most effective psychological treatment for moderate + severe depression shown in outcome studies. Engels conducted a meta-analysis of 28 studies, concluding that REBT was an effective treatment for depression. Ellis reported that over an average of 27 sessions, REBT had a success rate of 90%. These research studies expand on the tried and tested efficacy of CBT in depression treatment. 

Despite being a talking therapy that may not be suitable for patients who lack verbal skills or find discussing internal emotions difficult, CBT can still be accessible. Christensen examined an online form of CBT for depression and was found to be as effective as face-to-face therapy as well as cost effective. This shows how therapist subjectivity and potential client embarrassment that comes with CBT can still be overcome to give depressives a chance at recovery. 

Patients with severe depression may not have the motivation to engage in any CBT, so anti-depressants may be more suitable for these cases. In fact, initially using drug therapy or ECT may improve patients' symptoms short-term in which opportunity for CBT may be opened. This shows that CBT sometimes must depend on a combination of other treatments and can't always be effective as a sole treatment for depression.

CBT can become too therapist centred - leading to abuse of power. 

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OCD

anxiety disorder characterised by persistent, intrusive and irrational thoughts (obsessions) which force the sufferer to perform repetitive behaviours (compulsions). 

Obsessions are persistent, intrusive and irrational thoughts that lead to extreme anxiety in the sufferer e.g. believing that infectious germs are everywhere. 

Compulsions are excessive repetitive behaviours that sufferers perform to reduce anxiety created by obsessions e.g. repetitively washing hands. 

characterised by:

  • Behavioural - compulsions hinder everyday functioning, social impairment 
  • Emotional - obsessions create extreme anxiety and distress
  • Cognitive - persistent, intrusive thoughts, realisation of inappropriateness

 

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OCD Explanation + Evaluation

Genetic explanation - OCD is genetically inherited or is a result of genetic predisposition which causes changes in brain structure or abnormal levels of neurotransmitters. Bilet found MZ twins were 2x as likely to get the disorder if they had an affected twin. This implies that the more genetic material shared with an OCD sufferer, the more likely individual is to suffer the disorder themselves, strengthening the genetic explanation. However, there must be some phenotype influences upon the disorder as concordance rates are not 100%. This demonstrates that focusing on OCD only biologically is reductionist and environmental factors should be considered. A more holistic approach would be to examine OCD at it through the diathesis stress model. 

Neural explanation - Scans show relatively low levels of serotonin in the brains of OCD sufferers as compared to non-sufferers. These can be treated with anti-depressant drugs that raise levels of serotonin and have been found to reduce symptoms of OCD.  This does imply, therfore, that low levels of serotonin may be a neural cause of the disorder. However, not all sufferers respond positively to serotonin enhancing drugs, which lessens support for abnormal levels of this neurotransmitter being the sole cause of the disorder. 

There are different sub-types of OCD with maladaptive thinking - supports idea of OCD as being determined by cognitive rather than biological factors 

 

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OCD Treatment

Biological treatment of OCD employs drugs to re-balance levels of neurotransmitters e.g.

SSRIs are an anti-depressant that prevent the reuptake of serotonin and prolong its activity in the synapse to reduce anxiety 

Benzodiazepines - enhance the activity of GABA and therefore, slow down the CNS causing relaxation. 

Tricyclics produce similar effects to SSRIs but have more side-effects and only used if SSRIs have been unsuccessful. 

Psychosurgery - destruction of brain tissue associated with OCD. 

 

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OCD Treatment Evaluation

Soomro conducted a meta-analysis of 17 studies of SSRIs and found them more effective than placebos in reducing OCD symptoms for 3 months after treatment. 

in 50-80% of cases, SSRIs do not make symptoms fully disappear which weakens support for them. However, they do reduce symptoms to such a degree that a normal lifestyle can still be achieved for OCD sufferers. 

Drug therapy requires little effort from the user. Psychotherapy treatments require a lot of time, motivation and effort on patient's part which may not always be possible. Therefore, drug therapies are a more accessible form of treatment, especially in emergencies (those at risk of suicide)

Drug therapy addresses symptoms rather than the problem. Drugs may be effective at treating symptoms of OCD such as anxiety but effect only last during drug taking (may create dependency). In cases of chronic OCD, it may be preferable to seek a psychological treatment that addresses the underlying problem causing OCD. Drugs offer only a superficial, temporary solution that limits usage. 

Side effects of drugs in OCD treatment can produce heightened levels of suicidal and depressive thoughts. 

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