Psychopathology

• Definitions of abnormality: Statistical infrequency

  • Statistical infrequency - statistically uncommon behaviour e.g people below 70 IQ are abnormal, called intellectual disability disorder
  • Strengths: definition used in clinical practise for diagnosis and assessment of symptoms
  • Limitations: unusual characteristics of an individual can be positive e.g people above 70 IQ aren't seen as abnormal
• Definitions of abnormality: Deviation from social norms

  • Deviation from social norms - behaviour different from accepted standards e.g going outside without wearing shoes
  • norms are specific to culture e.g homosexuality is still illegal in many countries
  • according to the DSM-5 psychopaths are abnormal because they don't conform to social norms
  • Strengths: definition used in clinical practise for diagnosis and assessment of symptoms
  • Limitations: symptoms have cultural and situational relativism e.g hearing voices/auditory hallucinations in Haiti is perceived as communication from ancestors
• Definitions of abnormality: Failure to function adequately

  • Failure to function adequately - inability to cope with everyday demands e.g struggle to go to school or work
  • Rosenhan and Seligman identified signs of this:
  • individual no longer conforms to standard interpersonal rules
  • individual experiences severe personal distress
  • individuals behaviour becomes irrational or dangerous
  • Strengths: 25% of people experience mental health problems, therefore treatment is targeted at who needs it more
  • Limitations: people face discrimination for having different lifestyles
• Definitions of abnormality: Deviation from ideal mental health

  • Deviation from ideal mental health - individual doesn't meet ideal mental health
  • Jahoda suggested criteria for ideal mental health:
  • ability to cope with symptoms of stress
  • rationality
  • self-actualise
  • realistic view of the world
  • Strengths: criteria provides a checklist we can use to seek further help from psychiatrists and humanistic counsellors
  • Limitations: Jahoda's criteria are culture bound, mainly Westernised ideas, in some cultures self-actualisation is seen as self-indulgent
• Characteristics: Phobias

  • Behavioural - panic (crying, screaming, running away, freezing) avoidance (conscious effort to avoid phobic stimulus) endurance (conscious effort to remain in the presence of the phobic stimulus)
  • Emotional - anxiety (prevents relaxation) fear (immediate unpleasant response when thinking about or seeing phobic stimulus)
  • Cognitive - irrational beliefs (unfounded thoughts) cognitive distortions (inaccurate and unrealistic perceptions of phobic stimulus)
• Characteristics: Depression

  • Behavioural - activity levels (lethargy or psychomotor agitation) disruption to sleep (insomnia or hypersomnia) aggression (verbal aggression towards others or self-harm)
  • Emotional - lowered mood (feeling lethargic and sad) anger (verbal aggression towards others or self-harm) lowered self-esteem (reduced self-esteem)
  • Cognitive - poor concentration (indecisive and unable to stick at things) absolutist thinking (extreme negativity)
• Characteristics: OCD

  • Behavioural - compulsions (repetitive and reduce anxiety) avoidance (avoid situations which trigger OCD)
  • Emotional - anxiety (obsessions and compulsions are overwhelming) depression (co-morbid) guilt (over compulsions)
  • Cognitive - obsessive thoughts (recurring unpleasant thoughts) coping strategies (praying or meditating to manage anxiety)
• Behavioural approach to explaining phobias: Two-process model

  • acquisition by classical conditioning - learn to association neutral stimulus (no fear) with unconditioned stimulus (fear)
  • Watson and Rayner: created a phobia in a 9 month old baby 'Little Albert'
  • researchers made a loud noise which became associated with a rat, forming the fear generalised to other white objects
  • maintenance by operant conditioning - takes place when our behaviour is reinforced or punished, increasing frequency of the behaviour
  • Mowrer: avoid phobic stimulus means escape fear, reduction of fear reinforces avoid
• Strengths of the behavioural approach to explaining phobias: Two-process model

  • real world application to exposure therapies, identifies how they're formed and maintained which helps create suitable treatment
  • Watson and Rayner suggest phobias link to trauma, similarly Jongh found 73% of people with a fear of dental treatment had experience dental trauma
• Limitations of the behavioural approach to explaining phobias: Two-process model

  • not all phobias are caused by bad experiences, likewise not all frightening experiences lead to phobias
  • although it explains avoidance behaviour, doesn't offer an explanation for phobic cognitions, why someone thinks something is scary
• Behavioural approach to treating phobias: systematic desensitisation

  • systematic desensitisation - gradually reduce anxiety through classical conditioning, process called counterconditioning
  • had three stages:
  • Stage 1 - anxiety hierarchy - list established between client and therapist of situations related to phobic stimuli from least to most frightening
  • Stage 2 - relaxation - it is impossible to be afraid and relaxed at the same time, known as reciprocal inhibition
  • Stage 3 - exposure - exposed to phobic stimuli while in relaxed state, gradually making their way up the anxiety hierarchy
• Strengths of systematic desensitisation:

  • Gilroy: followed up 42 people after three 45 minute sessions suffering from arachnophobia, in 3 and 33 months were less fearful than control group treated without gradual exposure, therefore shows success of process
  • specifically beneficial for treating people with learning disabilities as they struggle with cognitive therapies and are distressed by the traumatic experience of flooding
• Behavioural approach to treating phobias: flooding

  • flooding - exposing people the phobia stimulus without gradual build-up of anxiety hierarchy
  • process of extinction whereby without the option of avoidance, the client quickly learns the stimulus is harmless
  • flooding is unethical but clients provide informed consent before starting the treatment
• Strengths of flooding:

  • cost-effective
  • time effective, can take as little as a day, 1 session of flooding is the equivalent to 10 sessions of systematic desensitisation
• Limitations of flooding:

  • Schumacher: found participants and therapists ranked flooding as significantly more stressful which raises ethical concerns
  • flooding has higher attrition rates than systematic desensitisation
• The cognitive approach to explaining depression:

  • Beck's negative triad:
  • faulty information processing - pessimistic views
  • negative schema - negative mental framework of the world, if a person has negative self-schema their perceptions will also be negative
  • negative triad - negative view of the self, the world and the future
• Strengths of explaining depression: Beck's negative triad

  • Cohen: tracked development of 473 adolescents, regularly measuring cognitive vulnerability which he founds predicts later depression
  • Cohen: concluded that assessing cognitive vulnerability allows psychologists to screen young people, identifying those most at risk of developing depression in the future
  • understanding depression can be applied to therapies such as CBT and is useful in clinical practise
• The cognitive approach to explaining depression: Ellis's ABC model

  • used to explain how irrational thoughts affect our behaviour and emotional state
  • A - activating event - situations triggering irrational beliefs
  • B - beliefs - identified a range of irrational beliefs
  • C - consequences - emotional and behavioural consequences of irrational beliefs
• Strengths of explaining depression: Ellis's ABC model

  • real world application to Ellis's Rational Emotive Behaviour Therapy (REBT)
• Limitations of explaining depression: Ellis's ABC model

  • only explains reactive and endogenous depression, triggered by life events, which isn't always how depression is formed
• The cognitive approach to treating depression:

  • Beck's negative triad: challenge a clients views
  • therapists may set them homework to record when they enjoyed an event or someone complimented them
  • if clients say in future sessions nobody likes them, therapists produce the clients evidence to prove they're incorrect
  • Ellis's Rational Emotive Behaviour Therapy (REBT): vigorous argument
  • ABC model plus D - dispute and E - effect
  • central technique is to identify and dispute over irrational thoughts
  • behavioural activism: increase a clients engagement in activities to improve moods
• Strengths to the cognitive approach to treating depression:

  • March: compared CBT to antidepressants and a combination of both when treating 327 depressed adolescents, found 81% of CBT group, 81% of antidepressants group and 86% of the combination improved, suggests its just as effective
• Limitations of the cognitive approach to treating depression:

  • diverse clients, Sturmey: any psychotherapy isn't suitable for clients with learning difficulties due to intense cognitive work
  • in extreme cases, some clients cannot motivate themselves to engage in the cognitive element, may find it hard to pay attention during sessions
  • relapse rates, Ali: assessed depression in 439 clients every month for 12 months following a course of CBT, found 42% relapsed within 6 months of stopping treatment and 53% in a year
• The biological approach to explaining OCD: Genetic explanations

  • candidate genes - specific genes which increase vulnerability
  • OCD is polygenic - combination of genetic variations that increase vulnerability (Taylor: found 230 genes involved)
  • types of OCD - aetiologically heterogenous (one combination of genes may cause OCD in one person, by a different combination may cause the disorder in another person)
• Strengths to the biological approach to explaining OCD: Genetic explanations

  • Nestadt: revised twin studies and found 68% of identical twins shared OCD as opposed to 31% of non-identical twins
  • research has found a person with a family member diagnosed with OCD is four times more likely to develop it as someone without
• Limitations to the biological approach to explaining OCD: Genetic explanations

  • Cromer: found that over half the OCD clients in their sample had experienced a traumatic event in their past, therefore genetic vulnerability only provides a partial explanation for OCD
• The biological approach to explaining OCD: Neural explanations

  • role of serotonin - regulates mood
  • if a person has low levels of serotonin, then normal transmission of mood-relevant information doesn't take place and a person may experience low moods
  • some OCD cases may be explained by a reduction in the functioning of the serotonin system in the brain
  • decision-making system - impaired decision-making
  • associated with abnormal functioning of the sides of frontal lobes, responsible for logical thinking
• Strengths of the biological approach to explaining OCD: neural explanations

  • antidepressants that work purely on serotonin are effective in reducing OCD symptoms, suggesting serotonin may be involved in OCD
• Limitations of the biological approach to explaining OCD: neural explanations

  • OCD is often co-morbid with depression, which causes a disruption to the action of OCD, it could therefore mean serotonin activity is disrupted in many people with OCD because they are depressed as well
• The biological approach to treating OCD:

  • SSRI's - work on serotonin system in the brain by preventing the re-absorbtion and breakdown of serotonin on the presynaptic neuron, takes 3-4 months of daily use for an impact
  • Combining SSRI's with other treatment - antidepressant SSRI's reduces emotional symptoms of anxiety, allowing effective engagement in CBT
  • alternatives of SSRI's - tricyclics (same effect as SSRI's but have severe side effects) SNRI's (used for people who don't react to SSRI's, increase levels of serotonin and noradrenaline)
• Strengths of the biological approach to treating OCD:

  • cost-effective, cheaper than psychological treatments so are good value for the NHS
  • non-disruptive
  • Soomro: review studies comparing SSRI's to placebos and concluded that 17 studies showed significantly better results for the SSRI's than the placebo
• Limitations of the biological approach to treating OCD:

  • drugs can face side effects such as indigestion and blurred vision which reduces the effectiveness, therefore people may stop taking medication
  • if medication is self-administered there is a high risk of relapse
  • Goldacre: believed the evidence favouring drug treatment is biased because the research is sponsored by drug companies who may withhold elements of research, therefore making the evidence unreliable