Psychopathology

• Definitions of Abnormality

  Statistical Infrequency - Behaviour that is statistically rare is considered abnormal, when looking at it on a distribution curve

  Deviation from social norms - Behaviour which is seen as unusual / not normal by society, as it breaks social expectations

  Failure to function adequately - Being unable to meet the demands of everyday life

  Deviation from ideal mental health - Deviation from Jahoda's six characteristics - Positive attitudes towards self, self actualisation, autonomy, resistance to stress, environmental mastery, accurate perception of reality
• Evaluation of Definitions of Abnormality

  Infrequency - An objective measure, BUT doesn't take into account the desirability factor - High IQ is infrequent but valuable

  Social Norms - Takes into account desirability factor, useful in diagnosing ASPD BUT cultural bias - different definitions of normal

  Function Adequately - Face validity, BUT not all mentally ill people fail to function

  Ideal Mental Health - Comprehensive Definition BUT highly idealistic / unlikely
• Characteristics of Depression


  Emotional - Low mood

  Cognitive - Poor concentration and negative automatic thoughts

  Behavioural - Hypersomnia, insomnia, changes to eating patterns

  Must show at least five symptoms, be present for two weeks, and affect daily life
• Beck's Negative Triad (cognitive)

  Cognitive Bias - Focusing only on negative aspects (overgeneralisation and catastrophising

  Negative Self Schemas - May come from negative experiences, e.g criticism, from parents, peers etc.)

  Negative Triad - Irrational and negative conclusions about themselves, the world, and their future
• Ellis's ABC Model (cognitive)


  Irrational thoughts increase the likelihood of depression.

  An Activating Event (somebody ignores you) leads to a Belief (nobody likes me), which leads to a Consequence (no longer trying to talk to people)
• Evaluation of Beck's Negative Triad

  Strength: Practical applications (basis for CBT)

  Weakness: Reductionist, ignores biological factors e.g low serotonin

  Explain's patterns of cognition, but doesn't take into account other emotions linked with depression like extreme anger or hallucinations
• Evaluation of Ellis's ABC Model


  Strength - Practical Applications (basis for CBT)

  Weakness - Reductionist, not all depression occurs following an activating event (e.g endogenous depression)
• Cognitive Behavioural Therapy (CBT)


  The cognitive element aims to identify irrational and negative thoughts, which lead to depression. The aim is to replace these negative thoughts with more positive ones.

  All CBT starts with an initial assessment, in which the patient and therapist identify the patient’s problems. Thereafter, the patient and therapist agree on a set of goals, and plan of action to achieve these goals.

  Initial assessment

  Goal setting

  Identifying negative/irrational thoughts and challenging these

  Homework
• Rational Emotive Behaviour Therapy (REBT)


  A variation of CBT, designed by Ellis. Similar to CBT, except it challenges irrational thoughts through "dispute", in order to replace them with healthy beliefs and attitudes.

  Examples include:

  Logical Dispute – where the therapist questions the logic of a person’s thoughts

  Empirical dispute – where the therapists seeks evidence for a person’s thoughts
• Evaluation of CBT


  Strengths:

  Supported by research evidence - March et al found in a sample group of depressed teenagers that 81% of the antidepressant group and 81% of the CBT group had significantly improved, demonstrating the effectiveness of CBT in treating depression (CP - Not generalisable due to sample)

  Weaknesses:

  Requires motivation, may not work for severely depressed patients who won't be motivated to do "homework" or even attend sessions

  More time consuming and expensive than antidepressants
• Evaluation of REBT


  Strengths:

  Has a 90% success rate after 27 sessions

  Weaknesses:

  Typically requires 27 sessions for success
• Characteristics of OCD


  Cognitive - Obsessions, hypervigilance

  Behavioural - Compulsions, Avoidance

  Emotional - Anxiety, depression

  People with OCD suffer from obsessions, and engage in compulsions in order to get rid of them. People with OCD know that their compulsions won't change anything, but they have to do them anyway.
• Explanations of OCD (Genetic)

  COMT - Regulates for clearing dopamine from the synapses. Low activity the COMT gene is associated with OCD.

  Sert(5-HTT)- Regulates the transportation of serotonin. Low levels of serotonin are associated with OCD.

  Polygenic - Estimated 230 genes are associated with OCD

  Aetiologically Heterogeneous - Different genes cause different types of OCD
• Explanations of OCD (Neural)

  Low serotonin is linked to anxiety and obsessions. High dopamine linked to overactive reward centre - rewarding compulsions so that you're more likely to repeat them

  High activity basal ganglia is more likely to reward repetitive movements/actions

  Orbitofrontal Cortex -  One suggestion is that heightened activity increases the conversion of sensory information to actions (behaviours) which results in compulsions
• Evaluation of the Genetic Explanation of OCD

  Strength:

  Supported by research evidence from twins studies (Nestadt found that the concordance rate for MZ twins was 68% compared to 31% for DZ twins) CP - Not 100%, shows that it's not guaranteed and there must be other factors

  Practical applications for drug studies

  Weakness:

  Biologically reductionist, ignores environmental factors such as stress (helps with the interactionist approach)
• Evaluation of the Neural Explanation of OCD

  Strengths:

  Supported by research evidence (Max et al found that when the basal ganglia is disconnected from the frontal cortex during surgery, OCD-like symptoms are reduced) CP - not 100% so there must be other factors

  Real world applications - drugs

  Weaknesses:

  Biologically reductionist - Cromer - over half of OCD patients had a traumatic event - stress diathesis model
• Characteristics of Phobias


  Behavioural - Panic / Avoidance

  Emotional - Anxiety / Fear (level of emotion must be disproportionate to the threat posed by the stimuli)

  Cognitive - Selective attention (can't look away) / Irrational beliefs / Cognitive distortions
• Behavioural Explanation of Phobias

  Two Process Model - Phobias are initiated through classic conditioning, and maintained through operant conditioning (negative reinforcement)

  Classical - e.g Little Albert played with a rat (NS), heard a loud noise (UCS), then the rat (now CS) produces a fear response (now CR)

  Operant - Avoidance of phobic stimulus negatively reinforced by anxiety reduction, so the phobia is maintained
• Evaluation of the Behavioural Explanation of Phobias

  Strengths:

  Real world application (basis for flooding and systematic desensitisation)

  Supported by research evidence (De Jongh - 73% of people with a dental phobia had past trauma compared to only 21% with no phobias ) CP - Not all phobias follow a particular event

  Weakness:

  Fails to account for cognitive aspects of phobias (e.g irrational fears)
• Systematic Desensitisation 


  Introducing a patient to a phobic stimulus that isn't particularly worrying, such as a photo of a spider. The patient is taught relaxation techniques, such as breathing methods. To move up to the next level of the fear hierarchy, the patiten
• Systematic Desensitisation 


  Introducing a patient to a phobic stimulus that isn't particularly worrying, such as a photo of a spider. The P is taught relaxation techniques, such as breathing methods. To move up to the next level of the fear hierarchy, the patient must be relaxed. Eventually, the P will be able to cope with the most serious stimulus using the relaxation methods . Works on the basis of reciprocal inhibition (you can't be relaxed and anxious at the same time)
• Flooding


  Rather than exposing somebody to their phobia gradually, the patient is immediately exposed to the most severe phobic stimulus, such as being forced to hold a spider. The patient is forced to confront the stimulus, and is therefore unable to negatively reinforce the phobia. Leads to extinction (the end of the phobia).
• Evaluation of Systematic Desensitisation

  Strengths:

  Supported by research evidence (Mcgrath - 75% of patients with phobias were successfully treated using systematic desensitisation)

  More accessible compared to flooding, the gradual nature means that it can be successful for people with learning disorders or anxiety

  Weakness:

  Time consuming compared to flooding
• Evaluation of Flooding


  Strength:

  Time and cost effective compared to systematic desensitisation - Extinction can occur in as little as one session

  Weaknesses:

  High attrition rate due its traumatic nature / Unethical (Schumacher - More stressful then SD)

  Less effective for phobias not caused by a particular event, e.g agoraphobia which may be caused by cognitive irrational thoughts
• Drug Treatment for OCD

  SSRI's - Serotonin is released from the pre-synaptic neuron into the synapse, aiming for the post-synaptic neuron. Serotonin which is not absorbed by the post-synaptic neuron is reabsorbed by the pre-synaptic neuron - SSRI's prevent this re-absorption and increases the level of serotonin in the synapse, making it more likely to bind and for the message to be passed on. (Prozac)
• Drug Treatment for OCD pt.2


  Tricyclics (Tofrani) work the same way as SSRI's but increase noradrenaline too

  BZ's (Valium) Enhance the GABA neurotransmitter, GABA tells the neurons in the brain to "slow down", which reduces anxiety and obsessive thoughts
• Evaluation of Drug Treatment for OCD


  Strengths:

  Requires little effort from patients - More appropriate for patients with severe OCD who may struggle to attend therapy

  Supported by research evidence (Soomro et al - MA of 17 studies of SSRI's, shows that they're more effective than placebos)

  Cheaper than therapy for health service (economic benefit)

  Weaknesses:

  Treats the symptoms of OCD but potentially not the root cause

  Potential side effects (BZ - addiction, aggression, memory problems)