Psychologists

• Rosenhan + Seligman (1989)

  Failure to Function Adequately

  Additional signs to determine if someone is not coping

  When a person no longer conforms to standard interpersonal rules (eye contact or personal space)

  When a person experiences extreme personal distress

  When a person's behaviour becomes irrational or dangerous to themselves or others
• Marie Jahoda (1958)

  Deviation from Ideal Mental Health

  Occurs when someone does not meet a set of criteria for good mental health

  Consider what makes someone normal and psychologically healthy and then identify who deviates from this ideal

  Good mental health:

  We have no symptoms or distress

  We are rational and can perceive ourselves accurately

  We self-actualise (strive to reach our potential)

  We can cope with stress

  We have a realistic view of the world

  We have good self-esteem and lack guilt

  We are independent of other people

  We can successfully work, love and enjoy our leisure

  Overlap between deviation from ideal mental health and failure to function adequately

  Provides a checklist against which we can assess and discuss psychological issues with professionals

  Culturally bound
• Mind

  Mental health charity

  Around 25% of people in the UK will experience a mental health problem in any given year

  Many people press on in the face of fairly severe symptoms

  Tends to be at the point that we cease to function adequately that people seek professional help or are noticed and referred for help by others

  Criterion means that treatment and services can be targeted to those who need them most
• Mowrer (1960)

  Two-process Model

  Phobias acquired by classical conditioning - learning to associate repeatedly paired together neutral stimulus with unconditioned stimulus which produces unconditioned response of fear

  Continue because of operant conditioning - negative reinforcement, individual avoids situation that is unpleasant, results in a desirable consequence (relief) which means the behaviour will be repeated

  When we avoid a phobic stimulus we successfully escape the fear and anxiety we would have experienced if we had remained there, reduction in fear reinforces the avoidance behaviour and so the phobia is maintained
• Watson and Rayner (1920)

  Acquiring phobias through classical conditioning

  9 month old baby called Little Albert

  No unusual anxiety at the start of the study, when shown a white rat he tried to play with it

  Whenever the rat presented researchers made a loud noise by banging iron bar by his ear (repetition)

  Noise, unconditioned stimulus = fear, unconditioned stimulus

  Rat, neutral stimulus + noise, unconditioned stimulus = fear, unconditioned response

  Rat, conditioned stimulus = fear, conditioned response

  Conditioning generalised to other similar objects

  Other furry objects, non-white rabbit, fur coat and Watson wearing cotton ball Santa Claus beard caused Little Albert distressed
• Ad De Jongh et al. (2006)

  73% of people with a fear of dental treatment had experienced a traumatic experience mostly involving dentistry, others victim of a violent crime

  This can be compared to a control group of people with low dental anxiety where only 21% had experienced a traumatic event

  Confirms the association between stimulus (dentistry) and an unconditioned response (pain) does lead to the development of phobias
• Craig Newman and Katie Adams (2004)

  Outlined the anxiety hierarchy they used to treat a phobia of dogs in a teenage boy with learning difficulties

  1. Introduction to dogs in photographs
  2. Dogs introduced without direct access
  3. Dog introduced to the same room
  4. Dog introduced to personal space on lead
  5. Loose dog introduced through a window
  6. Loose dog introduced but blocked by waist-high object
  7. Loose dog in the same room
  8. Repeated with different dogs
  9. Observe loose dogs in a park from a distance
  10. Close proximity to dogs in a park
• Lisa Gilroy et al. (2003)

  Followed up 42 people who had systematic desensitisation for spider phobia in 3 45-minute sessions

  At both 3 and 33 months SD group less fearful than control group who were treated with relaxation without exposure
• Theresa Wechsler et al. (2019)

  Concluded systematic desensitisation is effective for specific phobias, agoraphobia and social phobia
• Sarah Schumacher et al. (2015)

  Participants and therapists rated flooding as significantly more distressing than systematic desensitisation

  Ethical issues

  Informed consent tackles this

  Traumatic nature of flooding means that attrition (dropout) rates are higher than for SD

  Overall therapists may avoid this treatment
• Jacqueline Persons (1986)

  Behavioural therapies mask symptoms but do not tackle the underlying causes of phobias (symptom substitution)

  Reported the case of a woman with a phobia of death who was treated using flooding

  Her fear of death declined but her fear of being criticised got worse

  Case study so may just be individual specific phobias
• Bogetto et al. (2000)

  Trialled a drug called olanzapine

  23 people who had not responded to SSRIs

  10 responded to olanzapine

  Mean symptom rating improved from 26.8 to 18.9 on the Yale Brown Obsessive Compulsion Scale
• Petros Skapinakis et al. (2016)

  Although drug treatments are helpful for most people with OCD they may not be the most effective treatments available

  Carried out a systemic review of outcome studies and concluded that both cognitive and behavioural therapies were more effective than SSRIs in the treatment of OCD

  Drugs may not be the optimum treatment for OCD
• Mustafa Soomro et al. (2009)

  SSRIs reduce symptom severity and improve the quality of life for people with OCD

  Reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD

  All studies showed significantly better outcomes for SSRIs than placebo conditions

  Typically symptoms reduce for around 70% of people taking SSRIs

  The remaining 30% most can be helped by either alternative drugs or combinations of drugs and psychological therapies
• Gerald Nestadt et al. (2010)

  Some people are vulnerable to OCD as a result of their genetic makeup

  Reviewed twin studies

  68% of monozygotic shared OCD

  31% of dizygotic
• Kira Cromer et al. (2007)

  Found over half of the OCD clients in their sample had experienced a traumatic event in their past

  OCD was also more severe in those with one or more traumas

  Genetic vulnerability only provides a partial explanation for OCD
• Lewis (1936)

  Genetic explanations of OCD

  Assessed 50 OCD patients at Maudsley Hospital in London: 37% parents + 21% siblings with OCD

  Runs in families, genetic vulnerability

  Diathesis-stress model, certain genes increase likelihood to develop mental disorder, environmental stress necessary trigger
• Steven Taylor (2013)

  Analysed previous studies

  Found 230 different genes may be involved in OCD

  Genes studied associated with dopamine + serotonin, both neurotransmitters have a role in regulating mood

  Genetic basis to OCD
• John March et al. (2007)

  Compared CBT to antidepressants and also to a combination of both treatments

  327 depressed adolescents

  After 36 weeks: 81% of the CBT group, 81% antidepressants, 86% of CBT + antidepressants significantly improved

  CBT just as effective by itself and more so when used alongside antidepressants

  Fairly brief therapy requiring 6-12 sessions so it is also cost-effective

  CBT widely chosen as the first choice of treatment in public health care systems such as the NHS
• Peter Sturmey (2005)

  In general, any form of psychotherapy is not suitable for people with learning difficulties and this includes CBT

  CBT may only be appropriate for a specific range of people with depression
• Gemma Lewis and Glyn Lewis (2016)

  Review

  Concluded CBT was as effective as antidepressant drugs and behavioural therapies for severe depression
• John Taylor et al. (2008)

  Concluded when used appropriately CBT is effective for people with learning difficulties
• Shehzad Ali et al. (2017)

  Few early CBT studies looked at long-term effectiveness

  Assessed depression in 439 clients every month for 12 months following a course of CBT

  42% of the clients relapsed into depression within 6 months of ending treatment

  53% relapsed within a year

  CBT may need to be repeated periodically
• Antoine Yrondi et al. (2015)

  Depressed people rated CBT as their least preferred psychological therapy

  Not all clients want to tackle their depression this way

  Some people want their symptoms gone quickly and easily

  Trauma survivors wish to explore the origins of their symptoms
• David Clark + Aaron Beck (1999)

  Cognitive vulnerability - refers to ways of thinking that may predispose a person to becoming depressed

  Not only were cognitive vulnerabilities more common in depressed people but they preceded depression
• Joseph Cohen et al. (2019)

  Cognitive vulnerability - refers to ways of thinking that may predispose a person to becoming depressed

  Tracked the development of 473 adolescents

  Regularly measuring cognitive vulnerability

  Cognitive vulnerability predicted later depression

  
  

  Assessing cognitive vulnerability allows psychologists to screen young people

  Identifying those most at risk of developing depression in the future and monitoring them

  This can applied in CBT

  These therapies alter the kind of cognitions that make people vulnerable to depression making them more resilient to negative life events

  Understanding cognitive vulnerability is useful in more than one aspect of clinical practice
• Albert Ellis (1962)

  ABC model

  Depression occurs when an activating event triggers an irrational belief which in turn produces a consequence

  Irrational thoughts - any thoughts that interfere with us being happy and free from pain

  Activating event - situations where irrational thoughts are triggered by external events

  Belief - irrational beliefs

  Consequences - when an activating event triggers irrational beliefs there are emotional and behavioural consequences

  Rational emotive behaviour therapy extends the ABC model

  Dispute + Effect, identify and dispute irrational thoughts

  Break the link between negative life events and depression

  Empirical argument - disputing whether there is actual evidence to support the negative belief

  Logical argument - disputing whether the negative thought logically follows from the facts

  Does not explain endogenous depression, untraceable to an event
• Aaron Beck (1967)

  Negative triad

  3 kinds of negative cognitions that contribute to vulnerability to becoming depressed:

  Faulty information processing, negative self-schema, negative triad

  Person develops a dysfunctional view of themselves because of 3 types of negative thinking that occur automatically, regardless of reality at the time

  When a person is depressed, negative thoughts about the world, the future and oneself (negative triad) are uppermost

  Once identified these thoughts must be challenged

  Alongside challenging these thoughts directly, also aims to encourage the client to test the reality of their negative beliefs

  Might be set homework

  Client as a scientist