psychopathology

• definitions of abnormality
• statistical infrequency

  Under this definition of abnormality, a person’s trait, thinking, or behaviour is classified as abnormal if it is rare or statistically unusual.  With this definition, it is necessary to be clear about how rare a trait or behavior needs to be before we class it as abnormal. This definition also implies that abnormal behavior in people should be rare or statistically unusual, which is not the case. 
• deviation from social norms 


  A person’s thinking or behaviour is classified as abnormal if it varies from the (unwritten) rules about what is expected or acceptable behaviour in a particular social group. Their behaviour may be incomprehensible to others or make others feel threatened or uncomfortable. Social behaviour varies markedly when different cultures are compared.
• failure to function adequately

  Failure to function adequately refers to an abnormality that prevents the person from carrying out the range of behaviours that society would expect, such as getting out of bed each day, holding down a job, and conducting successful relationships, etc. Rosenhan & Seligman suggested seven criteria that are typical of FFA. These include personal distress , unpredictability , and irrationality, among others. The more features of personal dysfunction a person has, the more they are considered abnormal.
• deviation from ideal mental health


  Jahoda suggested six criteria necessary for ideal mental health. An absence of any of these characteristics indicates individuals as being abnormal, in other words displaying deviation from ideal mental health.

  • Resistance to stress
  • Growth, development, or self-actualization
  • High self-esteem and a strong sense of identity
  • Autonomy
  • Accurate perception of reality
• phobia


  A phobia is an anxiety disorder characterised by extreme and irrational fear towards a stimuli. Examples of phobias include: arachnophobia
• characteristics of phobias

  Emotional: people with phobias experience extreme fear that is uncontrollable and disproportionate to the situation.

  Behavioural: Screaming, crying, freezing, or running away from the feared stimuli. A phobic person will typically try to avoid the feared stimuli – for example, a person with aerophobia might stay away from airports.

  Cognitive: Most people with phobias recognise that their fear is irrational and disproportionate. However, this recognition does little to reduce the fear the phobic person feels.
• behaviourist approach to phobias - behaviourist explanation

  The two-process model

  The two-process model explains phobias as:

  • Acquired through classical conditioning, and
  • Maintained through operant conditioning.
• Humans naturally fear pain, and so a fear response to pain is unconditioned. But when this natural (unconditioned) response is associated with a neutral stimulus (e.g. a dog) through experience (e.g. a dog biting them), then a person can become conditioned to associate the response (fear) with the stimulus (dogs). This is an example of classical conditioning, which is based on the work of Ivan Pavlov.
• An example of this humans can be found in Watson & Rayner (1920). In their experiment, an 11 month old baby – ‘Little Albert’ – was given a white rat to play with. Albert did not demonstrate a fear response towards the rat initially, but the researchers then made a loud noise which frightened Albert. This process was repeated several times, after which Albert demonstrated fear behaviour (e.g. crawling away, whimpering) when presented with the rat (and similar stimuli such as a rabbit and a fur coat) even without the loud noise.
• Operant conditioning (maintenance of phobia)


  Classical conditioning - the conditioned response develops automatically. In contrast, operant conditioning occurs in response to behaviour, which is under a person’s control. If a person behaves in a way that produces a pleasurable outcome, then that behaviour is positively reinforced, making the person more likely to behave that way again. Similarly, if a person behaves in a way that reduces an unpleasant feeling, then that behaviour is negatively reinforced, also making them more likely to behave that way again.
• Within the two-process model, this sort of operant conditioning explains how phobias are maintained. Returning to the phobia of dogs example: A person with a conditioned phobia of dogs will feel anxiety in the presence of dogs. And so, avoiding dogs (e.g. by running away from them or avoiding parks) will lessen this anxiety, which negatively reinforces these dog-avoiding behaviours. This pattern of behaviour and reward via operant conditioning reinforces and thus maintains the phobia.
• BEHAVIOURIST TREATMENT OF PHOBIAS
• One behavioural treatment for phobias is systematic desensitisation. This involves gradually increasing exposure to the feared stimuli until it no longer induces anxiety. someone with arachnophobia may initially be asked to imagine spiders and guided through relaxation strategies until they can stay calm. Then, the process may be repeated with pictures of spiders, then real-life spiders in cages, and then repeated again with the subject actually holding a spider. example of classical conditioning: the subject is conditioned to associate the object with relaxation instead of anxiety.
• An example of successful treatment of phobia using systematic desensitisation is described in Jones (1924). A 2 year old boy – Peter – had a phobia of white rats and similar stimuli. Jones was able to remove Peter’s phobia over several sessions with him by progressively increasing his exposure to a white rabbit.
• Another behavioural approach to treating phobias is flooding. Whereas systematic desensitisation increases exposure step-by-step, flooding involves exposing the subject to the most extreme scenarios straight away. For example, returning to arachnophobia, the subject would be placed in direct contact with spiders until their anxiety response subsides.

  The idea behind flooding is that extreme anxiety cannot be maintained indefinitely. Eventually, the fear subsides and, in theory, the phobia.
• An example of successful treatment of phobia using flooding is described in Wolpe (1969). A girl with a phobia of cars was driven around in a car for four hours until she calmed down and her phobia disappeared.
• depression


  Depression is a mood disorder characterised by feelings of low mood, loss of motivation, and inability to feel pleasure. There are two kinds of depression: unipolar and bipolar. Bipolar depression (sometimes called manic depression) is characterised by the descriptions below + occasional manic symptoms whereas unipolar depression is characterised by these symptoms only with no manic episodes.
• characteristics of depression

  Emotional characteristics: People with depression experience persistent feelings of sadness and hopelessness. This low mood may come and go in cycles lasting months or years. Depression is also typically accompanied by feelings of worthlessness and a lack of enthusiasm.

  Behavioural characteristics: Low energy, reduced activity, and reduced social interaction. Depressed people may also have irregular sleep patterns and gain or lose weight from over- or under-eating.
• Cognitive characteristics: Depressed people may have exaggerated or delusional negative thoughts about themselves and what people think of them. They may have difficulty concentrating and remembering things. A depressed person may also regularly think about death and suicide.
• cognitive approach to depression - cognitive explanations 


  The cognitive approach analyses depression in terms of irrational and undesirable thoughts and thought processes (rather than e.g. the behaviours that result from these thought processes). The syllabus lists two cognitive explanations of depression: Beck’s negative triad and Ellis’ ABC model.
• Beck’s negative triad

  Beck (1979) argues that depression is characterised by a negative triad of beliefs about the self, the world, and the future:

  
• He argues that this negative triad results from and is maintained by two cognitive processes:

  • Negative schema
  • Cognitive biases
• Schema are patterns of thought – shortcuts/generalisations/frameworks – that are learned from experience to help make sense of the world and categorise information. Beck argued that experiences in childhood, such as criticism or failure to meet expectations, can cause depression-prone individuals to develop negative schema (i.e. a negative lens through which the individual views themself and the world). For example, experiences of failure in childhood may lead an individual to develop an ineptness schema whereby they constantly expect to fail.
• These negative schema are caused by and amplify cognitive biases. Biases are systematic deviations from an accurate perception of reality in favour of some less accurate interpretation. For example, a person who loses a game of chance may falsely interpret this as proof that he is simply an unlucky person.

  Together, these negative schema and cognitive biases maintain a negative triad of depressive beliefs about the self, the world, and the future.
• Ellis’ ABC model

  Ellis (1962) argued that depression results from irrational interpretation of negative events, rather than the negative events themselves. He explains this process using the ABC model of activating event, belief, and consequence.

  
• According to Ellis, we all have assumptions and beliefs (think schema) about ourselves and the world. With depressed people, though, these beliefs are often irrational and this leads them to interpret events (activating events) in an unrealistic way that causes a negative emotional reaction (consequence).

  Again, it is not the activating event itself that causes the negative emotional consequence, but the irrational belief through which the activating event is interpreted.
• cognitive treatment of depression

  The cognitive approach sees depression as caused by negative, irrational, and maladaptive thought patterns. Cognitive behavioural therapy (CBT) seeks to treat depression by identifying these depressed thought patterns and replacing them with alternate ones.

  CBT therapists help patients to identify depressed thought patterns.
• The therapist may then encourage the patient to question these depressed thought patterns and recognise them as unhelpful and not representative of reality. The patient is then encouraged to replace these irrational and unhelpful thoughts with more accurate and helpful thoughts. Replacing the depressed thoughts with more helpful thoughts affects the patient’s mood, which in turn affects the patient’s behaviour.
• There is often also a behavioural component to CBT. For example, therapy may involve scheduled activities, keeping a diary of thoughts, etc. 


  Albert Ellis developed a form of CBT based on his ABC model, known as rational emotive behaviour therapy (REBT).

  
• Obsessive-compulsive disorder (OCD) is an anxiety disorder characterised by continuous and repeated undesirable thoughts (obsessions) and uncontrollable behaviours and rituals in response to these thoughts (compulsions). A person may have an obsessive fixation on germs, which leads them to constantly worry that everything is unclean and dirty. These thoughts may lead to compulsive hand-washing behaviour and rituals as the individual tries to alleviate these obsessive worries.
• CHARACTERISTICS OF OCD

  Emotional characteristics: High levels of anxiety and stress in response to obsessive thoughts and inability to control compulsive behaviours.

  Behavioural characteristics: Continuous repetition of rituals and behaviours in response to obsessive thoughts. Both the obsessive thoughts and the compulsive behaviours get in the way of everyday functioning, disrupting normal activities such as work and social interaction.
• Cognitive characteristics: OCD sufferers will continually repeat thoughts to do with their obsession and cognitive biases mean they have difficulty focusing on anything else. Many OCD sufferers are aware their obsessive thoughts are inappropriate and exaggerated but are unable to control them.
• BIOLOGICAL EXPLANATIONS OF OCD

  genetic explanation - Genes are inherited biologically from parents. There is evidence that genes contribute to the development of OCD.
• twin studies suggest a genetic component to OCD. Grootheest et al (2005) conducted a review of more than 70 years of studies on twins and OCD using various methods. One of these methods compared the rates of OCD between identical twins and between non-identical twins. The researchers found it was far more likely for both identical twins to have OCD than for both non-identical twins to have OCD.
• This supports a genetic role in OCD: Identical twins have identical genetics and so if there is a genetic component to OCD it would make sense that both twins would be similarly prone to developing OCD. With non-identical twins, the different genes could explain why one twin was more likely to develop OCD than the other.
• Other studies have used gene mapping to identify correlations between certain genes and OCD. For example, Davis et al (2013) compared the genetic profiles of 1500 OCD sufferers with 5500 non-OCD controls. The researchers’ method (genome-wide complex trait analysis) looked for traits across the entire genome (rather than looking for individual genes) and found the OCD sufferers often shared similar genetic elements that were not present in the non-OCD controls.
• The neural explanation of OCD

  Brain scans consistently show that OCD sufferers have increased activity in the orbital frontal cortex area of the brain (e.g. Saxena and Rauch (2000). The orbital frontal cortex is sometimes called the ‘worry circuit’ and is responsible for high-level decision making and thinking. When you have an impulse (e.g. to wash your hands when they are dirty), the orbital frontal cortex translates that impulse into action (e.g. washing your hands), and performing that action reduces the impulse.
• However, with OCD sufferers, it may be that the overactivity of the orbital frontal cortex means these impulses continue even after performing the behaviour, becoming obsessions and compulsions.

  Other studies implicate hyperactivity of the basal ganglia in OCD (e.g. Max et al (1995)).
• Another possible neural explanation of OCD is neurochemistry. For example, several studies (e.g. Hu et al (2006)) suggest that OCD sufferers have lower levels of the neurotransmitter serotonin compared to controls. Some brain scans also suggest OCD sufferers have higher dopamine levels than healthy controls.