Psychopathology Paper 1

• Statistical infrequency


  Behaviour is abnormal if it is rare or statistically unusual
• Evaluation of statistical infrequency

  • This definition works well for characteristics which can be measured objectively, e.g. IQ.
  • assumes that anyone whose behaviour differs from average is abnormal, and common behavior is normal. However, some unusual behaviour is desirable, e.g. an IQ score over 130, while some undesirable behavior e.g. depression is relatively common.
  • The cut off point for normality/abnormality is unclear. 
• Deviation from social norms

  behaviour is abnormal if it is not socially acceptable and breaks the norms and expectations of a particular society or culture
• Evaluation of deviation from social norms

  • This definition distinguishes between desirable and undesirable behaviour and takes into account the effects on others.
  • The definition does not allow for context to be taken into account, suggesting it may not be an accurate way of defining abnormality. 
  • The definition may not be useful over time as social norms change, suggesting that the definition can’t be applied consistently and will have to be updated often.
  • some norms need to be broken in order that social change through resistance movements can occur.
• Failure to function adequately

  Behaviour is abnormal if it prevents the individual from living a normal and successful life in their culture

  Rosenhan and Seligman suggested there were 7 features of abnormality:

  1. Violation of moral standards
  2. Irrationality
  3. Observer discomfort
  4. Unpredictability
  5. Unconventionality
  6. personal discomfort
  7. Maladaptive behaviour
• Evaluation of failure to function adequately

  • A strength is that it it does attempt to include the subjective experience of the individual, allowing one to view mental disorder from the point of view of the person experiencing it
  • Most of the features may be shown for quite normal reasons such as grieving quite normal, and it would be considered abnormal not to be distressed.
  • It is not clear how extreme the behaviour has to be in order to be considered abnormal.
  • the definition is culturally relative and so not applicable to all cultures. 
• Deviation from ideal mental health

  • Behaviour is abnormal if it is not psychologically healthy and deviates from Jahoda's criteria for optimal living:

  1. Positive attitudes towards.self
  2. autonomy
  3. accurate perception of reality
  4. environmental mastery
  5. resistance to stress
  6. self-actualisation
• Evaluation of deviation from ideal mental health

  • It is very clear and covers a broad range of criteria for mental health
  • Most people don’t meet all these ideals all of the time
  • The criteria are quite difficult to measure
  • Jahoda’s emphasis on personal growth and individual autonomy reflect Western ideals of individualism and would be considered undesirable, unhealthy and abnormal in collectivist cultures where the focus is on the greater good of the community, suggesting the definition may be culturally relative
• Phobias

  an extreme, irrational fear leading to intense anxiety and avoidance of an object or situation
• Emotional characteristics of phobias

  • fear
  • anxiety
• Behavioural characteristics of phobias

  • avoidance of feared object
  • panic - crying, freezing, running
• cognitive characteristics of phobias

  • irrational beliefs
  • selective attention to phobic object
• Emotional characteristics of depression

  • lowered mood
  • low self-esteem
  • anger and aggression
• Behavioural characteristics of depression

  • reduced energy
  • disruption to sleep
  • disruption to eating
  • self harm
• cognitive characteristics of depression

  • negative self belief
  • guilt
• OCD

  • an anxiety disorder
• Emotional characteristics of OCD 

  • anxiety
  • guilt and disgust
• Behavioural characteristics of OCD

  • compulsions that are often repetitive
  • avoidance of situations that may trigger anxiety
• Cognitive characteristics of OCD

  • obsessions
• Mowrer's two-process model of explaining phobias

  1. learning a phobia by classical conditioning
  2. maintaining a phobia by operant conditioning
• Learning a phobia by Classical Conditioning

  • people learn to associate something that they do not initially fear with something that does cause a fear response, e.g. Watson and Rayner caused Little Albert to have a phobia of rats.
  • he gained a phobia through associating the rat with a bang. 
  • Albert’s fear generalised to similar objects, so after conditioning Albert showed fear of other similar objects
• Maintaining a phobia by Operant conditioning

  • Positive reinforcement is a reward -e.g. family and friends give a person attention when they show fear of an object or situation, so the fear response is reinforced and is likely to be maintained. 
  • Negative reinforcement is removal of something unpleasant - e.g. avoiding a feared object or situation removes feelings of anxiety, and means the avoidant behaviour is repeated. 
• Evaluation of behavioural explanation of phobias

  • supported by Watson and Rayner who created a phobia of white rats in Little Albert
  • applications for therapies because it explains why patients need to be exposed to the feared stimulus and prevented from avoiding it
  • Bouton suggests evolutionary factors probably have an important role, as it is adaptive to acquire such fears and thus, we seem to have a biological preparedness towards developing such fears.
  • Menzies and Clarke found that only 2% of children with a water phobia reported a direct conditioning effect involving water
• The Behavioural Approach to treating phobias 

  1. systematic de-sensitisation
  2. flooding
• systematic desensitisation

  • It reduces the learned link between anxiety and objects/situations that produce fear.
  • The aim is to reduce or eliminate phobias that sufferers find are distressing or impair their ability to manage daily life.
  • By substituting a new response to a feared situation phobic reactions are diminished or eradicated.
  • This is based on the principle of reciprocal inhibition that 2 opposing physiological states cannot occur at the same time.
  • This learning of a different response is called counter-conditioning.
• Steps of systematic de-sensitisation

  1. Deep relaxation techniques
  2. Anxiety hierarchy
  3. Gradual exposure to phobic object using deep relaxation techniques
• Evaluation of systematic desensitisation

  • Gilroy compared phobic patients treated with SD with a control group and found the SD group showed less fearful responses
  • Denholtz et al found 60 % of clients treated for a flying phobia continued to fly during following 3 years
  • more ethical than flooding
  • ignores any deeper issues that may be involved, e.g. Wolpe found a woman with a phobia of insects did not respond well to SD, as it turned out her husband was nicknamed after an insect - a marriage counsellor successfully treated her. 
  • flooding is more effective
• Flooding

  • extreme exposure to the phobic situation for long periods of time where the patient is not allowed to leave until anxiety levels have reduced substantially
  • the assumption is that as the physical response reduces, so will the anxiety associated with facing the phobic object.
  • A typical session may last for three hours and aims to extinguish the phobic response.
• Evaluation of flooding

  • Kaplin found 65% of patients with a phobia given a single session of flooding showed no symptoms 4 years later.
  • Flooding works quickly and is thus a more cost-effective method for treating phobias.
  • Flooding raises ethical issues concerning acceptable levels of suffering by patients and means they may drop out of treatment.
  • Flooding is less effective for some more complex phobias such as social phobias, perhaps because they have cognitive aspects 
• Cognitive approach to explaining depression

  1. Ellis's ABC Model
  2. Beck's Cognitive Theory
• Ellis' ABC Model

  • Depression is a result of irrational thoughts
  • A - activating event
  • B - beliefs
  • C - consequence
  • It is the irrational belief about the event, rather than the event itself, which causes depression
  • Ellis identified a range of irrational beliefs, such as musturbation - the belief one must always succeed
• Beck's Cognitive Triad

  • depression stems from unrealistic, distorted or negative thoughts, creating a cognitive vulnerability towards developing the disorder
  • Beck identified 3 forms of negative thinking (Cognitive Triad) that are responsible for depressed thinking: negative views about oneself, the world and the future. 
  • Depressed people may have developed negative schemas in childhood that has led to cognitive biases in thinking, e.g. generalisation and focusing on negative aspects
• Evaluation of the cognitive approach to explaining depression

  • Grazioli and Terry assessed 65 pregnant women for cognitive vulnerability and depression before and after giving birth and found women judged high in cognitive vulnerability were more likely to suffer post-natal depression.
  • it cannot account for cases of depression that occur as a result of no obvious cause
  • Therapy based on Beck’s cognitive approach and Ellis' ABC model have been effective in treating depression.
  • The cognitive approach ignores biological factors that might be involved in depression.
• treating depression - CBT

  • The goal of CBT is to challenge negative, irrational thoughts.  
  • One form of CBT is Rational Emotive Behaviour Therapy ,which focuses on disputing irrational beliefs and replacing them with rational beliefs.
  • Logical disputing- realising beliefs are not logical.
  • Empirical disputing- realising beliefs are not realistic 
  • Pragmatic disputing- realising beliefs are not useful
  • Another form is based on Beck’s theory, where the therapist identifies and challenges negative thoughts, perhaps through setting the clients 'homework' (patient as scientist)
• Evaluation of CBT

  • Hollon et al studied the relapse rates of those with depression and found rates of 40% in those who’d had CBT, 45% in the drug therapy group and 80% in the placebo group.
  • CBT attempts to deal with the cause of depression, not just the symptoms of it
  • CBT is not appropriate for all clients
  • not enough emphasis placed on the circumstances in which a patient is living, e.g. poverty, poor housing, which may may prevent a client from dealing with a major source of their problems. 
  • CBT may take a relatively long time to complete
• Genetic explanation for OCD

  • OCD is polygenic, with up to 230 genes causing the disorder
  • the SERT gene appears to be mutated, leading to an increased reuptake of serotonin into the neutron, decreasing levels in the synapse
  • the COMT gene appears to be mutated, causing a decrease in COMT activity, leading to increased levels of dopamine
• evaluation of the genetic explanation for OCD

  • Pauls et al found up to 10 % of first-degree relatives of those with OCD were more likely to develop the disorder compared with 2% prevalence in the general population.
  • family studies do not control for the effects of the environment.
  • Nestadt et al found 68 % of MZ twins showed concordance for OCD compared to 31% in DZ twin
  • there are no studies that show 100% concordance in MZ twins.
  • MZ twins may be treated more similarly than DZ twins, which may partly account for Nestadt’s findings.
  • biologically reductionist
• Neural explanations for OCD - abnormal levels of neurotransmitters

  • Neurotransmitters are chemical messengers that send messages to nerve cells
  • OCD may be caused by low levels of the serotonin, which means normal transmission of mood-relevant information does not take place and mood and other mental processes are affected.
  • This is based on OCD being relieved by anti-depressant drugs, especially those which increase serotonin
  • disruption of serotonin levels has a knock-on effect on regulating the levels of other neurotransmitters, such as glutamate, GABA, and dopamine, which may cause OCD
• evaluation of neural explanations-neurotransmitters

  • Zohar et al found that drugs increasing serotonin are beneficial for up to 60%
  • However, most studies found only 50% improvement of symptoms when using medication, suggesting other factors are involved. 
  • It is unknown if the problems with neurotransmitters are a cause or a consequence of OCD, known as the aetiology fallacy
  • The reason serotonin may be low in people with OCD could be due to the fact that they often suffer with depression as well, but not all have depression which means the low serotonin found may be a causal factor
• neural explanations of OCD - abnormal brain circuits

  • the worry circuit has been implicated in OCD
  • The orbitofrontal cortex sends signals to the thalamus about worrying things such as a potential germ hazard.
  • These are normally supressed by the caudate nucleus (part of the basal ganglia) if deemed irrelevant or unimportant. 
  • When the caudate nucleus is damaged, it fails to suppress minor worry signals and the thalamus is alerted, making us take action.
  • This then sends signals back to the OFC, acting as a worry circuit.