Psychopathology

• Definitions of Abnormality - Deviation from Social Norms

  Abnormality: behaviour that goes against unwritten social norms in society. Specifically concerned with antisocial/undesirable behaviour.
• Evaluation of DSN

  Face validity: most people see behaviours against the norm as abnormal, and people with mental disorders e.g social phobics often portray this kind of behaviour

  Cultural Relativity & Temporal Validity: cultural norms change all the time and vary between cultures, which creates problems for people from one culture living in a different country as they may be perceived as abnormal
• Definitions of Abnormality - Failure to Function Adequately

  Abnormality: behaviour that shows an individual cannot cope with the demands of everyday life e.g being unable to work or maintain relationships. Their behaviour interrupts with day to day living, or (according to some definitions) grant observer discomfort.
• Evaluation of FFA

  Real life application: allows a way to distinguish between disorders and feelings (we all feel sad sometimes, but people are diagnosed with depression when it affects their ability to live)

  Subjective: no particular criteria for what is inadequate, who decides it? E.g. people with high functioning schizophrenia may feel fine but if they create observer discomfort they might be seen as abnormal. Influenced by personal feelings

  Abnormality isn't always FFA: a doctor killed 200 patients but was still able to maintain his professional life publicly
• Definitions of Abnormality - Statistical Infrequency

  Abnormality: behaviour which is uncommon, strays far from the average. Uses a normal distribution curve, people who are outside of the normal distribution (2.5% each side) are abnormal
• Evaluation of SI

  Objective: way of measuring abnormality free of bias, and the cut off point can be decided and standardised. E.g. for Intellectual Disability Disorder the cut off point is an IQ of below 70 (very rare)

  Doesn't focus on desirability: many abnormal behaviours are infrequent but desirable e.g. high IQ and many are common but still harmful, e.g. depression is common but that doesn't mean we should accept it as normal showing we need to look beyond the numbers
• Definitions of Abnormality - Deviation from Ideal Mental Health

  Start from normality/good mental health and work backwards. The criteria for good mental health are:

  • Positive attitudes towards the self
  • Self actualisation and personal growth
  • Being resistant to stress
  • Personal Autonomy
  • Accurate perception of reality
  • Environmental Mastery

  Deviating from even 1 of these makes you vulnerable to disorders
• Evaluation of DIMH


  Sets unrealistically high standards: according to this criteria, most people would be abnormal it is difficult to fulfil all of these. They are also difficult to measure to see the extent to which you fulfil them

  Cultural Relativity: characteristics are rooted in individualistic societies, e.g. personal autonomy may not be as important to someone from a collectivist culture as it is common for elders to choose a spouse for them etc, but they may still be content. Cannot apply to all cultures
• What are phobias?

  Categorised within anxiety disorders, irrational fears that produce an avoidance of the feared object. Three types:

  • Specific phobias: animal/situational phobias e.g. planes or dogs
  • Social phobias: excessive fear of social situations e.g. eating in public
  • Agoraphobia: fear of public places
• Behavioural Characteristics of Phobias

  Panic in the presence of the stimulus, e.g. running away, crying

  Avoidance of the phobic stimulus

  Endurance, alternative to avoidance; sufferer remains in the presence of the phobic stimulus but experiences high levels of anxiety
• Emotional Characteristics of Phobias

  Anxiety: prevents the sufferer from relaxing or experiencing any positive emotion. Fear is the immediate response

  Disproportionate emotional responses: too extreme for the situation, do not match the danger posed by the stimulus
• Cognitive Characteristics of Phobias

  Decrease in Concentration: difficult to concentrate in the presence of the phobic stimulus which causes an inability to complete tasks

  Irrational Beliefs: increases the pressure to perform well, makes the situation more uncomfortable. E.g. social phobics may think people will think they're weak if they blush
• Two Process Model (1)

  Emphasises the role of learning in the acquisition of behaviour, explains the panic, avoidance, and endurance aspects. Suggests that phobias are acquired by classical conditioning and are maintained by operant conditioning

  Acquisition: associating something which initially does not illicit fear with something that already triggers a fear response. E.g. dog (NS) bites (US) you, creates fear (UR) and then the dog becomes a CS to produce fear (CR) E.g. little Albert, who was not afraid of white rats initially but became afraid, and also demonstrated stimulus generalisation
• Two Process Model (2)

  Maintenance: operant conditioning maintains the phobia through negative reinforcement as reinforcement increases the frequency of behaviour. Individual avoids the negative sensation (coming in contact with the phobic stimulus) which results in desirable consequences (lack of anxiety) so the behaviour will be repeated and the phobia will continue as they continue to avoid the phobic object
• Evaluation of the Two Process Model

  Research Support: conditioned rats to fear a buzzer by electric shocks, then used operant conditioning to train the rats to jump over a barrier when the buzzer sounded to prevent the shocks (negative reinforcement)

  Goes beyond acquisition: effects of classical conditioning wear away over time so using operant conditioning to explain maintenance is more explanatory. Also, helped develop therapies such as systematic desensitisation. Its effectiveness supports this model
• Behavioural Approach to treating Phobias - Systematic Desensitisation

  Aim: behavioural therapy, gradually reduces phobic anxiety through classical conditioning. Elicit relaxation response in presence of stimulus instead of anxiety (counter conditioning) as can't occur at same time (reciprocal inhibition). Faulty association replaced

  Process:

  • Relaxation is taught by the therapist e.g. breathing exercises
  • Anxiety hierarchy is created together to list situations from most anxiety inducing to least
  • Gradual exposure: exposed to phobic stimulus in a relaxed state and move up the hierarchy
• Evaluation of Systematic Desensitisation

  More preferable to flooding: less traumatic as it goes in stages so has lower refusal/attrition rates. Also more appropriate for young children or the elderly.

  Does not treat the root: some psychologists suggest that phobias have a deep root cause and that treating the symptoms without addressing the reason for the phobia will cause the issue to show up in other parts of their life
• Behavioural Approach to Treating Phobias - Flooding

  Aim: expose the sufferer to the phobic stimulus for an extended period of time in a controlled and safe environment.

  Process:

  • Immediate exposure to the phobic stimulus (in-vivo)
  • Lasts until the person is calmed (phobic response is exhausted - extinction) and they acknowledge the stimulus is harmless. This means that sessions can be long but fewer are required
  • Patients are prevented from avoiding the phobic stimulus as this prevents them from learning that the stimulus is harmless
  • Informed consent required as it's a difficult experience
• Evaluation of Flooding

  Effectiveness: a psychologist drove around a woman who had a fear of cars, initially she was hysteric but eventually realised she was safe and associated a sense of ease with cars from then on

  Unpleasant experience and can be psychologically harmful so a cost benefit analysis must be done prior to the therapy

  (only treats the symptoms)
• Depression

  Depression: mood disorder characterised by extreme sadness. Must experience at least 5 symptoms to be diagnosed

  Emotional characteristics: depressed mood, loss of interest in usually enjoyable activities, worthlessness

  Cognitive characteristics: reduced concentration, negative beliefs about the self, suicidal thoughts

  Behavioural characteristics: change in activity (fatigue/psychomotor agitation), change in eating/sleeping patterns, social impairment
• Cognitive Explanations of Depression - Beck's Negative Triad

  Cognitive approach: explains in terms of negative/faulty thought processes

  Depression is caused due to negative thinking, which comes before the development of depression. Depression has 3 components:

  • negative thoughts about the self, feelings of inadequacy etc
  • negative thoughts about the world/experiences
  • negative thoughts about future, no improvements possible

  These form a cycle of depressing thoughts where negative schemas and cognitive biases (eg overgeneralisation) cause depression
• Cognitive Explanations of Depression - Ellis ABC Model

  Depressives mistakenly blame external events for their unhappiness but their interpretation of events (irrational thoughts) causes depression.

  A - activating event, B - belief, C - consequence which the belief leads to. Event does not cause the consequence, belief does.

  Depressed people interpret unpleasant experiences in extremely negative ways
• Evaluation of Cognitive Explanations for Depression

  Can't establish cause and effect: difficult to distinguish if depression occurs as a result of negative schemas or if negative schemas are caused by depression (which could develop due to other factors) despite the fact that studies show depressives are more likely to display negative thinking

  Practical Applications: these models have led to development of various therapies such as CBT

  Reductionist: doesn't take into account the potential biological aspect (low levels of serotonin)
• Cognitive Approach to Treating Depression - CBT

  Aim: identify, challenge, and modify negative thoughts and cognitive biases and alter dysfunctional behaviours that worsen depression

  Cognitive strategies:

  • Thought catching - identifying negative thoughts (journalling)
  • Cognitive restructuring - challenging irrational thoughts and replacing them with more positive, rational ideas to improve symptoms. HW: act scientifically and test thoughts

  Behavioural strategies:

  • Behavioural activation - identify potentially joyful activities and obstacles preventing them. HW: experimenting with activities
• Ellis' Rational Emotive Behavioural Therapy


  Uses disputing to challenge irrational thoughts

  Change self defeating beliefs into rational beliefs -> healthier and more realistic interpretation of events -> client feels more positive and self accepting

  Types of disputing:

  • Empirical: are the beliefs consistent with reality? Provide evidence
  • Logical: do the beliefs follow on coherently from the information available? Do they make sense?
  • Pragmatic: are the beliefs useful? Do they make you feel worse for no reason?
• Evaluation of Cognitive Treatments for Depression

  Depends on the Therapist: one study suggests that the competence of the therapist can affect outcome by ~15%, showing that there are issues in its reliability as it depends on how well trained the therapist is. -> CBT is more expensive for the NHS than drugs as it requires therapists who have specific training and cannot be mass distributed -> better longevity than drugs as it addresses the root cause and not just the symptoms -> doesn't work for all patients as they may not be motivated enough to engage with the work
• Obsessive Compulsive Disorder


  OCD: anxiety disorder characterised by obsessions/compulsions.

  Obsessions: persistent & unwanted thoughts which cause anxiety and distress. They are neutralised through various thoughts/actions

  Compulsions: repetitive behaviours or mental acts in response to an obsession. Reduce anxiety of a negative event occurring, often unrealistic
• Characteristics of OCD


  Cognitive characteristics: persistent thoughts of intrusive nature which are uncontrollable, awareness that they are irrational, catastrophic thoughts

  Behavioural characteristics: repetitive behaviours, compulsions which reduce anxiety

  Emotional Characteristics: anxiety and distress, guilt over minor moral actions
• Biological Approach to Explaining OCD - Genetic

  Suggests that OCD traits are inherited through genes. 10% with a close relative with OCD suffered from OCD compared to 2% in the control

  A candidate gene (create a vulnerability) for OCD is the SERT gene.

  When mutated, SERT gene creates lower levels of serotonin which prevents communication between different parts of the brain which triggers OCD

  Low activity COMT gene -> higher dopamine levels -> anticipation of rewards -> seek rewards -> compulsions
• Evaluation of Genetic Explanations for OCD

  Research support: 68% concordance rate for MZ twins vs 31% DZ twins HOWEVER findings show that OCD is more severe when the person has experienced more than one trauma, and more likely when trauma occurred suggesting there is also an environmental factor to developing OCD

  OCD is polygenic: OCD is most likely to be caused by a combination of candidate genes, but it is difficult to identify which and to what extent they affect. Therefore, it is not useful as it provides no predictive value
• Biological Explanations for OCD - Neural

  Abnormal Levels of Neurotransmitters: low levels of serotonin. Serotonin prevents repetition of tasks and anti depressants that increase serotonin help OCD symptoms

  Abnormal Brain Circuits: caudate nucleus (in basal ganglia) suppresses signals from the orbifrontal cortex which sends worry signals (e.g. germ hazard) to the thalamus. The caudate nucleus is damaged in people with OCD so the worry signals are never suppressed
• Evaluation of Neural Explanations for OCD

  Objective research support: PET scans of OCD patients show that when symptoms are active there is higher activity in the OFC, and studies have found excessive activity in the caudate nucleus in OCD patients

  Cannot establish cause and effect: although there is empirical evidence to show unique activity in the brains of OCD patients, we cannot be sure if this is due to OCD or caused by OCD
• Biological Approach to Treating OCD

  Drug Therapy:

  • Selective Serotonin Reuptake Inhibitors: reduce anxiety associated with OCD by increasing levels of serotonin. They block the absorption of serotonin at the presynaptic nerve so there is mores serotonin available at the synapse. 3-4 months of daily use for improvement
  • Anxiolytics (benzodiazepines): treat anxiety by increasing effectiveness of GABA which has a quietening effect on brain activity
• Evaluation of Drug Therapy for OCD

  Not a lasting cure: after completing a course of medication the symptoms return. 45% relapsed compared to 12% who did psychotherapy instead

  Drugs cause side effects: leads to refusal/attrition. Side effects include nausea, insomnia, impairment of memory and addiction

  Don't disrupt day to day life so people may find them easy to take