psychopathology

• Statistical Infrequency


  Defined as abnormal if behaviour is rare

  
  

  example - fear of buttons = abnormal

  example - fear of heights = normal

  
  

  Strengths: Real Life Application, Objective - clear cutoff point

  
  

  Weaknesses: Doesn't take into account severity of behaviour, Some abnormal behaviours are desireable, Cultrual relativism - behaviours are different in different cultures
• Deviation from social norms

  Behaviour seen as abnormal if behaviour deviates from the rules of society

  explicit norms - refers to rules in a society that are policed by laws - eg wearing no clothes on a nudist beach wouldnt have you arrested but wearing no clothes in central london would

  implicit norms - refers to unwritten rules of society - getting up for a pregnant women if there are no seats

  
  

  Strengths: Distinguises between desirable and undesirable behaviour, helpful when diagnosing mental disorders

  
  

  Weaknesses: Cultral relativism - behaviour in different cultures differs, Social norms = subjective, Social norms vary over time
• Failure to function adequately


  Behaviour is abnormal when their behaviour suggests they cannot cope with the basic demands of everyday life

  3 criterias for this abnormality

  1) a person no longer conforms to interpersonal rules - holding eye contact, respecting personal space

  2) a person experiences severe personal distress

  3) a person behaviour becomes irrational or dangerous to themselves or others

  
  

  Strengths: Includes subjective experiences of the patient

  
  

  Weaknesses: Could just be a deviation from social norms, Requires judgement from external person
• Deviation from Ideal mental health

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

  1 - Congruence - having high self esteem and a strong sense of identity

  2 - Self-Actualisation - the extent to which a person develops their true capabilities

  3 - Integration - being a functioning member of society, able to cope with stressful situations

  4 - Autonomy - being independent and self reliant

  5 - Accurate perception of reality - having an objective and rational view of the world and yourself

  6 - Mastery of the environment - the ability to love function at work and relationships and enjoy our leisure

  
  

  Strengths: Positive approach, Broad range of criteria, focuses on desirable behaviours rather than individual failures

  
  

  Weaknesses: Cultural relativism - Self-actualisation = Western, Unrealistic standards - very few meet criteria
• Characteristic of Phobias


  Behavioural: Panic - Crying, Screaming, Avoidance

  Cognitive: Irrational beliefs, Selective attention - focusing on stimuli

  Emotional: Anxiety
• How phobias are formed

  Phobias are acquired by Classical Conditioning- Associate something we have no fear of initially (Neutral Stimulus) with something that naturally triggers a fear response (Unconditioned Stimulus). NS + UCS = CR of fear

  Phobias are then maintained by Operant Conditioning- Once phobia formed, likely we will avoid the stimulus- Avoiding phobias is negative reinforcement- This relieves our anxiety making us feel good (Reinforcing), so phobia maintained as it increases the likelihood of us avoiding it in the future
• PEEL for explanations of phobias

  1) Strength = good explanatory powerTwo-process model explained how phobias are maintained over time; through operant conditioning. This had important implications for therapies

  To be treated, the patient needs to be exposed to the feared stimulus.

  If a patient is prevented from avoiding it, the phobia stops being reinforced

  Led to development of treatments - systematic desensitisation and flooding

  2) Weakness = ignores evolutionary factors

  Easily acquire phobias of dangers in the past i.e. snakes, heights and the dark. It is adaptive to acquire these"biological preparedness" - innate predisposition to acquire certain fears - fear of cars + guns rare as not evolutionaryShows not all fears are conditioned and why some are more common than others

  3) Weakness = not all phobias have an explicit cause Some phobias appear after a traumatic event, but some develop without being aware of any prior experience

  Fear of spiders or snakes example - some never come into contact with before but still have a phobia of one

  Further limitation of two-process model - suggests phobias are learned through exposure instead of feared stimulus
• Systematic Desensitisation


  Reduces phobias through classical conditioning

  - Counter conditioning, relearning to associate phobic stimulus with relaxation instead of anxiety

  
  

  Anxiety Hierarchy: Patient and therpaist put list of phobic stimulus ranked in order from most to least frightening

  Relaxation: Therapist teaches patient how to relax as deeply as possible - breathing techniques, drugs e.g valium

  Gradual Exposure: Patient exposed to phobia while relaxed, Several sessions, start at bottom and work way up

  
  

  Strengths: Effective, patients prefer it

  Weaknesses: Symptom substitute, one phobia disappears; another takes its place
• Flooding


  Imediate exposure to very frightening situation

  - Patients cannot avoid phobia so cannot be reinforced through negative reinforcement

  
  

  Strengths: Cost effective, quicker than other methods

  Weaknesses: Less effective for complex phobias, traumatic for patients - some unwilling to go through with it
• Characteristics of Depression


  Behavioural: Change in activity levels - withdraw from work, education, social life. Aggression and Self-harm

  Cognitive: Poor concentration, Dwelling on the negative

  Emotional: Anger, Lowered Self-esteem, Low mood
• Beck's Cognitive Theory

  Faulty Information Processing

  - Depressed people have cognitive biases, blow small problems out of proportion

  Negative Self-Schemas

  Low self-esteem
• Beck's Negative Triad
• Ellis' ABC Model

  
• PEELs for explanations of depression

  1) Strength = Good supporting evidience

  Grazoli and Terry: Assessed 65 pregenent women for cognitive vulnerability before and after giving birth. Those with 'high cognitive vulnerability' were more likely to develop post-natal depression

  Hammen and Krantz: Depressed patients make more errors in logic when asked to judge a written scenario than other non-depressed patients

  High external validity

  
  

  2) Strength in practical application in CBT

  Beck's theory fors basis of CBT - identifying automatic thoughts linked to negative triads is key to helping patients understand the world around them more logically

  Ellis' ABC model to teach patients about their thought processes and to identify irrational thoughts to change behaviour

  CBT has helped millions of people worldwide

  
  

  3) Weakness = Doesn't explain all aspects of depression

  Not all depression routed in thought processes, Beck + Ellis struggle to explain anger patients feel

  Cognitive theories of depression are explained through cognitive primacy - the idea emotions are influenced by your cognition first which isn't always the case

  Lacks explanatory power can be seen as reductionist
• Cognitive Behavioural Therapy (CBT)

  Treatment for depression

  Patient + Therpaist identify irrational thoughts and maladaptive behaviours to replace these with more rational thoughts and coping stratagies
• Rational Emotive Behavioural Therapy


  Extends ABC model(D)ispute irrational thoughts and (E)xchanging these for more rational and balanced ones

  Done through vigorous arguments between patient and therapist
• PEEL paragraphs for treatments for depression

  1) Strength = CBT is effective in majority of cases

  March et al: Compared the effects of CBT with antidepressant drugs (SSRIs) and a combination of the 2 in 327 depressed adolescents

  After 36 weeks - 81% if CBT only, 81% of SSRI only and 86% CBT + SSRI were significantly improved. Shows CBT is just as effective as drug

  Drugs work better with CBT suggest CBT should be used in treating depression

  
  

  2) Weakness = May not work for severe cases

  Can be so severe patients cannot motivate themselves to fully engage with therapy

  CBT usually takes place over a number of months and in 1-2hr long sessions which may be daunting for someone with depression

  Patients can start on drugs then go onto CBT - shows CBT is not effective enough alone

  
  

  3) Weakness = Doesn't tackle root cause of depression

  CBT focuses on present and future not the past, can annoy patients who know a cause of their depression but do not address it in CBT

  CBT can ignore important environmental factors that cause the depression, e.g poverty and abuse

  CBT equips patients with coping methods, more effective to tackle actual cause directly instead
• Characteristics of OCD


  Behavioural: Compulsive to reduce anxiety, Social impairment, hindered everyday function

  Cognitive: Recurrent uncontrolable persistent obsessing thoughts

  Emotional: Extreme anxiety, Guilt, Accompying depression
• Genetic explanations for OCD

  Candidate genes are genes which have been found to create a vulnerability for OCD

  SERT gene: Transport of seratonin across the synapse, producing lower levels of the neurotransmitter

  OCD is polygenetic - (230 genes involved)

  Aetiologically heterogenous - multiple combinations can cause OCD

  Diastheisis-stress model - genes give vulnerability - needs enviromental trigger
• Neutral explanations for OCD

  Role of Seratonin: Neurotransmitters relay information from one neuron to another. Serotonin is an inhibitory neurotransmitter which has a calming effect on the nervous system

  - People with OCD have too little Seratonin in their brain

  - which means they are less likely to feel calm

  
• PEELs for explanations of OCD


  1) Strength = good supporting evidence

  Lewis - 37% concordance rate of OCD if a parent has OCD, 21% if a sibling has it

  Nestadt - 68% concordance rate between MZ twins, 31% for DZ twins

  SSRIs work in treatment of OCD b/c they increase levels of seratonin

  Shows some involvement of biology

  
  

  2) Weakness = Biological explanations tell us little about the causes of OCD

  No one system has been found that always plays a role in OCD, things happening in the brain could be a result of OCD, rather than causing it

  Genes play a role, but due to OCD being polygenetic - no one specific gene, genes often require trigger (Diathesis-stress)

  Biologically reductionist only considers biological factors

  
  

  3) Weakness = ignore environmental factors

  Diasthesis-stress model explains how genes create vulnerability but not a guarentee, only 68& concordance in MZ twins despite identical genes

  Cromer et al - Over half of the OCD patients in their sample had a notable traumatic event in their past - OCD was more severe in those with more than one trauma

  More holistic approach needed
• SSRI drugs


  20mg dosage - 3-4 months to have an effect, Increases level of seratonin in brain. Serotinin is released at the synapse of one neuron to pass a signal on to the next, if not used in the synapse, it goes back to the presynaptic neuron via reuptake pump. In patients with OCD they have less serotinin in areas like the orbitofrontal cortex. Drug works by blocking reuptake pump, giving serotonin more chances to cross the synapse
• Alternative treatments for OCD


  Drugs are often used in conjunction with CBT. Dosage can be upped to 60mg, if no response move to tricyclis. SNRIs another option, increase levels of noradrenaline aswell as serotonin
• PEEL paragraphs for treatments for OCD

  1) Strength = effective at tackling symptoms

  Soomro et al - Meta-analysis of 17 studies of SSRIs. All 17 studies showed bettwen outcomes from SSRIs in comparison to placebos. SSRIs work for around 70% of people

  Cost effective, minimal effort, less disruptive to patients lives

  Combination of CBT + drigs os gp tp

  
  

  2) Weakness = can cause serious side effects

  small minority will get no benefit fro SSRIs, just side effects like indigestion, blurred vision and loss of sex drive

  Positive outcomes short lived, slowly need higher doses - result in dependancy - CBT avoids

  Positive effects of SSRIs biased from big drug companies

  
  

  3) Weakness = not all cases of OCD have a biological origin

  Strong evidence for biological basis of OCD - other unknown causes

  OCD can be limited to trauatic experiences which trigger obsessvie compulsive response as coping mechanism

  Biological treatments are reductionist - treat symptoms not cause