Psychopathology

Statistical infrequency

Regards behaviours that are very rare as abnormal. Uses descriptive statistics which can be used to represent the typical value in any set - can be used to define what is common and thus what is not common.

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Strength of statistical infrequency

Can sometimes be appropriate e.g. intellectual disability can be defined using statistical infrequency - someone whose IQ is two standard deviations below the mean has a mental disorder.

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Limitations of statistical infrequency

Many abnormal behaviours are quite desirable e.g. a high IQ. It is difficult to separate normality from abnormality - the cut-off point may be subjective. Cultural relativism - behaviours may be more common in some cultures.

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Deviation from social norms

Regards deviation from social rules as abnormal behaviours. In societies, there are standards of acceptable behaviour that are set by the social group and adhered to by that group. So, anyone who behaves differently is seen as abnormal.

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Strengths of deviation from social norms

Distinguishes between desirable and undesirable behaviour unlike statistical infrequency. Considers how abnormal behaviour affects others; social rules are established to help people so it recognises that abnormal behaviour can damage others.

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Limitation of deviation from social norms - Susceptible to abuse

Mental health professionals may classify people as mentally ill who go against social attitudes. Thomas Szasz (1974) thought that the idea of mental illness was simply a way to exclude nonconformists from society.

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Limitations of deviation from social norms

Deviance is related to degree and context - in many cases, there isn't a clear line between abnormal deviation and eccentricity. Cultural relativism - there are no universal standards.

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Failure to function adequately

Regards not being able to cope with everyday living as abnormal behaviour e.g. eating regularly and going to a job. Not functioning adequately causes distress to the person and sometimes to others.

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Strengths of failure to function adequately

Sees mental disorder from the view of the person suffering from it; recognises the subjective experience of the patient. It is quite easy to judge objectively; we can list behaviours and judge abnormality appropriately.

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Limitations of failure to function adequately

Difficult to decide what is functioning adequately - some people are happy with their situation but others are not and see it as abnormal. It depends who is making the judgement. Some dysfunctional behaviour can be adaptive and functional.

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Deviation from ideal mental health

Jahoda (1958) proposes that the absence of certain criteria which measure mental health indicates abnormality: self-attitudes, personal growth and self-actualisation, autonomy, having an accurate perception of reality and mastery of the environment.

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Strength of deviation from ideal mental health

Takes a positive approach. Focuses on desirable behaviour (positives) rather than undesirable behaviour (negatives). Jahoda's ideas have had some influence and are apart of the 'positive psychology' movement.

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Limitations of deviation from ideal mental health

Unrealistic criteria - according to these criteria, most of us are abnormal and some criteria are difficult to measure e.g. self-actualisation. Suggests that mental health is the same as physical health - it shouldn't be diagnosed in the same way.

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Phobias

A group of mental disorders in which the person experiences high levels of anxiety and an irrational fear of a stimulus or a group of stimuli.

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Depression

A mood disorder in which the person feels sad and can lose interest in normal activities.

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OCD

An anxiety disorder in which obsessions and compulsions cause anxiety. The individual believes that the compulsions will reduce the anxiety.

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Obsessions

Persistent thoughts

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Compulsions

Behaviours that are repeated over and over again and are done in response to obsessions.

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Emotional characteristics of phobias

Marked and persistent fear which is likely to be excessive and unreasonable. Feelings of anxiety and panic as well. Emotions are cued by the presence or anticipation of a stimulus.

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Behavioural characteristics of phobias

Avoidance - when a person has a phobia and is faced with that stimulus, they try to avoid it. This interferes with the person’s normal routine and life. There is also the opposite response to freeze or faint.

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Cognitive characteristics of phobias

Irrational thinking and resistance to rational arguments. The person recognises their fear is excessive or unreasonable.

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Emotional characteristics of depression

Sadness is very common, along with feeling empty - they may feel worthless and have a low self-esteem. There are feelings like despair and a lack of control which are linked to a lack of interest in usual activities. Also, there are feelings of anger

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Behavioural characteristics of depression

Shift in activity level - reduced or increased. They may want to sleep all the time but some become increasingly agitated and restless. Some sleep more whereas others find it difficult sleeping. Appetite may also be affected.

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Cognitive characteristics of depression

People experience negative thoughts, like a negative self-concept. They have a negative view of the world and expect things to go wrong. These negative thoughts are irrational and do not reflect reality.

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Emotional characteristics of OCD

Obsessions and compulsions cause anxiety and distress. People know that their behaviour is excessive - causes feelings of embarrassment and shame.

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Behavioural characteristics of OCD

Compulsive behaviours are repetitive and unconcealed. People feel they have to perform these acts otherwise something terrible might happen.

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Cognitive characteristics of OCD

Obsessions are repetitive, intrusive thoughts which are seen as inappropriate and may be embarrassing or frightening. These thoughts are seen as uncontrollable. They recognise that these thoughts come from their mind.

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Who was the two-process model proposed by?

Mowrer (1947)

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The two-process model

Explains the two processes that lead to the development of phobias: it begins through classical conditioning and is maintained through operant conditioning.

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Operant conditioning: Maintenance

The likelihood of a behaviour being repeated is increased if the outcome is rewarding. With phobias, the avoidance of the phobic stimulus reduces fear and so is reinforcing – negative reinforcement.

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Bandura and Rosenthal (1966) - Support for social learning theory

Had a model act as if he was in pain every time a buzzer sounded. Participants who saw this showed an emotional reaction to the buzzer.

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Di Nardo et al (1981) - Criticism of the two-process model

found that not everyone who is bitten by a dog develops a phobia of dogs. Can be explained by the diathesis-stress model – people have genetic vulnerabilities for developing mental disorders but can only develop due to a life event.

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The two-process model ignores cognitive factors

the cognitive approach suggests that phobias may develop due to irrational thinking e.g. a person in a lift could think ‘I could become trapped in here’. This creates extreme anxiety and may trigger a phobia.

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Systematic desensitisation

Form of behavioural therapy based around counterconditioning - the patient is taught a new association that runs counter to the original association. Through classical conditioning, they learn to associate the stimulus with a new response.

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Step 1 of systematic desensitisation

The therapist teaches the patient relaxation techniques e.g. focusing on their breathing and taking slow, deep breaths.

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Step 2 of systematic desensitisation

The therapist and patient construct a hierarchy of fears - a series of situations involving the phobic stimulus in which each one will cause more anxiety. In SD, a patient is gradually exposed to their phobia so that they are not overwhelmed.

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Step 3 of systematic desensitisation

Patient gradually moves through the hierarchy using relaxation techniques so that the situation becomes more familiar, less fearful and their anxiety reduces.

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Step 4 of systematic desensitisation

Once a patient has mastered one step and are relaxed in this stage, they can move onto the next.

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Step 5 of systematic desensitisation

Patient masters the feared situation which caused them to seek help for their phobia.

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McGrath et al (1990) - Research support for systematic desensitisation

Reported that 75% of patients with phobias respond to SD.

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Humphrey (1973) - Effectiveness of self-administering SD

Found that this self-administered SD could be successful with social phobia.

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Ohman et al (1975) - SD is not appropriate for all phobias

Suggest that SD may not be effective in treating phobias which have a basis in evolution (fear of heights, dangerous animals), compared with treating phobias acquired through personal experience.

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Flooding

Form of behavioural therapy in which the patient experiences their phobia at its worst while practicing relaxation. A person’s fear response (the release of adrenaline) has a time limit and adrenaline levels naturally decrease.

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Choy et al (2007) - Effectiveness of flooding

Reported that both flooding and systematic desensitisation were effective but flooding was the more effective of the two.

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Craske et al (2008) - Effectiveness of flooding

Concluded that SD and flooding were equally effective in treating phobias.

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Individual differences with flooding

Flooding isn’t for every patient - it is a very traumatic experience. Patients are aware of this beforehand but they can still quit in the treatment so this reduces how effective it can be for some people.

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What is Ellis' ABC Model (1962)?

Ellis believed that the key to depression lay in irrational beliefs. A - an activating event. B - belief, which may be rational or irrational. C - consequence; rational beliefs lead to healthy emotions but irrational beliefs lead to unhealthy emotion

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Ellis' ABC Model (1962) - Mustabatory thinking

This is the source of irrational beliefs – this is thinking that certain ideas or assumptions must be true in order for an individual to be happy.

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What did Ellis think the three most important irrational beliefs were?

I must be approved or accepted by people I find important. I must do well or very well, or I am worthless. The world must give me happiness, or I will die. An individual, who holds such assumptions, is likely to be disappointed, at worst depressed.

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What is Beck’s Negative Triad (1967)?

Beck believed that depressed individuals feel as they do as their thinking is biased towards negative interpretations of the world and they lack a sense of control.

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Beck's Negative Triad (1967) - Negative schema

Depressed people have acquired a negative schema during childhood (due to peer/ parental rejection etc.) – a tendency to adopt a negative view of the world. They are activated when a person is in a new situation that resembles the original situation.

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What do negative schemas lead to?

Cognitive biases - over-generalising, making sweeping conclusions on self-worth from one small piece of negative feedback.

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Beck's Negative Triad (1967) - The negative triad

A pessimistic and irrational view of three key elements of a person’s belief system: the self, the world (life experiences) and the future. This is maintained by negative schemas and cognitive biases.

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Bates et al (1999) - Support for irrational thinking

Found that depressed participant given negative automatic-thought statements became more and more depressed; negative thinking leads to depression. Although there is a link between negative thoughts + depression one doesn't cause the other.

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Blames the client rather than situational factors

It may lead the client or therapist to overlook situational factors e.g. not considering how life events or family problems may have led to their depression. The client may need to change aspects of their environment and life to improve.

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Alloy and Abrahmson (1979) - Not all irrational beliefs are irrational

Suggest that depressive realists tend to see things for what they are. They found that depressed people gave more accurate estimates of the likelihood of a disaster compared with ‘normal’ people – the sadder but wiser effect.

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Cognitive-behavioural therapy (CBT)

A combination of cognitive therapy (a way of changing maladaptive thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts).

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CBT - Albert Ellis

He was one of the first psychologists to develop a form of CBT. He called it ‘rational therapy’ to emphasise how psychological problems are due to irrational thinking and the aim of the therapy is to turn these irrational thoughts into rational ones.

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What did Ellis extend his ABC model to?

ABCDEF. D is for Disputing irrational thoughts and beliefs. E is for Effects of disputing + Effective attitude to life. F is for new Feelings that are produced.

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Why does CBT focus on challenging irrational thoughts?

It is not the activating events that cause destructive consequences but the beliefs that lead to the self-defeating consequences.

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What does this therapy try to replace these irrational thoughts with?

Effective rational beliefs: Logical disputing, Empirical disputing, Pragmatic disputing.

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Logical disputing

Irrational beliefs do not follow logically from the information available.

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Empirical disputing

Irrational beliefs may not be consistent with reality.

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Pragmatic disputing

Shows the lack of usefulness of irrational beliefs.

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CBT - Homework

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

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CBT - Behavioural activation

CBT focuses on encouraging clients to become more active and engage in pleasurable activities – being active leads to rewards that act as an antidote to depression. They identify pleasurable activities and anticipate and deal with cognitive obstacles

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CBT - Unconditional positive regard

The therapist provides the client with respect and admiration despite what they say. This will cause a change in beliefs. if the client feels worthless, they will be less willing to change their beliefs and behaviour.

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Ellis (1957) - Research support

Claimed a 90% success rate in REBT and it took an average of 27 sessions to complete the treatment.

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Cuijpers et al (2013) - Research support

Review of 75 studies found that CBT was superior to no treatment.

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Elkin et al (1985) - Individual differences

Found that CBT was less suitable for people who have high levels of irrational beliefs which are rigid and resistant to change.

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Ellis (2001) - Individual differences

Suggested that CBT may not be successful because it is not suitable for some people; some people do not want the direct advice given out by CBT practitioners.

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Alternative treatments

The most popular treatment for depression was the use of anti-depressants e.g. SSRIs. Drug therapies require less effort by the client than CBT. They can also be used in conjunction with CBT.

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The COMT gene

It is involved in the production of COMT which regulates the production of the neurotransmitter dopamine that has been implicated in OCD.

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The neurotransmitter dopamine

One of the key neurotransmitters in the brain and it affects motivation and ‘drive’.

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Tukel et al (2013) - The COMT gene

Found that a variation of the COMT gene is more common in OCD patients than ones without the disorder. It produces lower activity of the COMT gene and higher levels of dopamine.

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The SERT gene

It affects the transport of serotonin, creating lower levels of this neurotransmitter, but higher levels have also been implicated in OCD.

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Ozaki et al (2003) - The SERT gene

Found a mutation of this gene in two unrelated families where six of the seven family members had OCD.

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Diathesis-stress - OCD

A gene only creates a vulnerability (diathesis) for OCD and other factors (stressors) affect what condition develops or whether any mental illness develops.

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Billett et al (1998) - Evidence from twin studies

Meta-analysis found that on average, MZ twins were more than twice as likely to develop schizophrenia if their co-twin had the disorder in comparison with DZ twins. But, concordance rates are never 100% - diathesis-stress.

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Real-world application

There is hope that specific genes could be linked to particular mental disorders, so if one parent has, for example, the COMT gene, parents could decide whether to abort the fertilised eggs or even there could be a way of ‘turning off’ specific genes

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What is an alternative explanation of the biological explanation for OCD?

Psychological explanations e.g. the two-process model.

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How does the two-process model explain OCD?

The patient learns to associate a neutral stimulus with anxiety and it is maintained because this stimulus is avoided. So, an obsession is formed and a link is learned with compulsive behaviours which seem to reduce anxiety.

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What is the two-process model in explaining OCD supported by?

The success of a treatment of OCD called exposure and response prevention (ERP) which is similar to systematic desensitisation.

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Albucher et al (1998) - Alternative explanation

Found that between 60 and 90% of adults with OCD have improved considerably using ERP.

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Albucher et al (1998) - Alternative explanation

Found that between 60 and 90% of adults with OCD have improved considerably using ERP.

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Psychopathology

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