Psychopathology

• The DSM 5 Categories of Depression are:

  -Major Depressive disorder = severe but short term

  -Persistent depressive disorder = long term recurring depression

  -Disruptive mood dysregulation disorder = Childhood temper tantrums

  -Premenstrual dysphoric disorder = Disruption to mood during menstruation
• The behavioural characteristics of depression are:

  • Activity levels = Low energy, lethargic making people withdraw from work or school or in extreme cases cannot get out of bed
  • Disruption to sleep and behaviour = Reduced sleep or an increase in sleep and weight gain or loss
  • Aggression or self harm = People become verbally or physically aggressive to others and one self
• The emotional characteristics of depression are:

  -Lowered mood = Daily experience of feeling sad, lethargic, worthless and empty

  -Anger = Anger and potential violence to others and one self

  -Lowered self-esteem = People like themselves than usual and sometimes cases of self loathing - hating themself
• The cognitive characteristics of depression are:

  • Poor concentration = Feel they are unable to stick with a task or find it hard to make straightforward decisions, likely to interfere with ones work
  • Attending to and dwelling on the negative = Pay more attention to negative stimuli and not positive. Also contain a bias to remember negative thoughts instead of positive
  • Absolutist thinking = When a situation is bad, they believe to see it as an absolute disaster
• Aaron Beck (1967) took a cognitive approach to explaining why people are more vunerable to depression than others
• First section Beck (1967) proposed was faulty information processing. This is where depressed people tend to focus more on the negative aspects of their life instead of the positive - often referred as 'black and white thinking'
• Second section Beck (1967) proposed was negative self-schema. It is the way people interpret themselves, therefore someone depressed will interpret themselves as worthless and empty
• The Third Section Beck (1967) proposed was the the negative triad:

  • Negative view of the world = There is no hope anywhere in the world
  • Negative view of the future = Thoughts reduce hopefulness and demotivates
  • Negative view of the self = Thoughts increases depressive feelings and confirm the existing thoughts of low self esteem
• How does Beck's CBT treat Depression - Cognitive

  • The client and therapist uses Beck's Negative Triad to identify any negative thoughts and challenge them
  • The Therapist also aims to help the client test the reality of their negative beliefs
  • The client can create a diary of positive and negative events, that the therapist can use later on in treatments
• How does Ellis ABCDE treat depression - Cognitive

  • It challenges the irrational thoughts and beliefs of the clients
  • The Therapist identifies the problem and challenge it as an irrational belief, causing a direct argument
  • The point is to try and break the link between negative life events and depression
  • There are different types of disputing = empirical disputing is stating whether there is evidence to support the negative belief
• Negative of Beck's CBT

  • Lack of effectiveness, Doesn't treat severe cases, so severe that people cannot be motivated to go to sessions or concentrate, therefore only limited to certain group
  • High relapse in depression rates, cannot effectively tackle depression in the long term, Shehzad (2017) followed 439 clients for 12 months who followed CBT course. 42% relapsed into depression 6 months after and 53% relapsed after a year. CBT must be repeated
• Strength of Beck's CBT

  • Supporting evidence for its effectiveness in treating depression. John March (2007) compared CBT with antidepressant drugs and combination of both when treating 327 depressed adolescents. After 36 weeks, 81% of both CBT and antidepressant drugs and 86% of both CBT and antidepressants had both signifcantly improve
  • CBT is cost effective. It only takes 6-12 sessions for it to be effective, therefore saving time and cost for NHS. Therefore, effective as it is widely seen as first choice treatment in NHS for depression
• Behavioural Characteristics of Phobias

  • Panic = May elicit response of crying, screaming or running away when seeing phobic stimulus
  • Avoidance = Tend to put a lot of effort in to prevent coming into contact with the phobic stimulus
  • Endurance = Person chooses to remain in the presence of the phobic stimulus to make sure they keep an eye on it
• What are the 3 different types of phobias

  • Specific Phobia = Phobia of an object or situation eg animals or flying
  • Social Anxiety = Phobia of social situations eg public speaking or using public toilets
  • Agoraphobia = Phobia of being in an outside space
• Cognitive Characteristics of Phobias

  • Cognitive distortions = The perception of a phobia may be inaccurate and unrealistic
  • Irrational beliefs = People may hold unfounded thoughts about phobic stimulus
  • Selective attention to phobic stimulus = If a person sees a phobic stimulus, they find it very hard to look away from it
• Emotional Characteristics of Phobias

  • Anxiety = An unpleasant state of high arousal (Long term)
  • Fear = Immediate and unpleasant response in presence of phobic stimulus (short term)
  • Emotional response is unreasonable = The Fear and anxiety is much greater than normal
• Emotional Characteristics of OCD

  • Anxiety and Distress = Unpleasant emotional experience due to powerful anxiety causing compulsions to be repetitive
  • Accompanying Depression = Anxiety can be accompanied by low mood and self esteem
  • Guilt and Disgust = OCD brings round irrational thoughts of guilt and disgust directed at something external
• Cognitive Characteristics of OCD

  • Obsessive Thoughts = The thoughts that repeat over and over again
  • Cognitive coping strategies = Methods of relieving the obsessions eg someone religious will pray
  • Insight into excessive anxiety = People are aware their obsessions and compulsions are not rational, however people with OCD experience catastrophic thoughts in the worst case scenario that the anxieties were justified
• Behavioural Characteristics of OCD

  • Compulsions are repetitive = OCD sufferers feel compelled to repeat a behaviour eg handwashing
  • Compulsions reduce anxiety = Compulsive behaviours are performed in an attempt to reduce anxiety produced by obessions
  • Avoidance = Attempting to reduce anxiety by keeping away from the situations that trigger it
• What did Aubrey Lewis (1936) find about OCD

  • 37% of patients stated that their parents had OCD
  • 21% of patients stated that their siblings had OCD
• How does Candidate Genes explain OCD

  • Researcher's have identified candidate genes that create vunerability to OCD
  • These genes regulate the development of serotonin
• What did Ellis (1964) suggest about OCD

  • He proposed that a good mental health is the result of rational thinking, and poor mental health is from irrational thinking
• How does Ellis's (1964) ABC model explain Depression?

  • Activating Event = Ellis focused on the irrational thoughts that came from external factors (failing a test or breakup in relationship)
  • Beliefs = Ellis identified musturbation, where we must always achieve perfection, Utopian-ism is when life should be perfect and a belief where when something doesn't go smoothly, it is a disaster
  • Consequences = When the activating even triggers irrational beliefs, there are emotional and behavioural consquences (failing a test where we believed we should of been perfect can bring depression)
• What is one strength of Ellis's 1964 ABC model?

  • It has real world value in the treatment for depression
  • Ellis's REBT coincides with the ABC model, where the therapist vigorously argues with the client until they alter the irrational beliefs
  • REBT can change the negative beliefs and symptoms alongside it (David 2018)
  • Therefore, REBT has real world value
• What is one limitation of Ellis's 1964 ABC model?

  • It lacks reliability explaining some elements of depression
  • It can only treat reactive depression as it can be traced what the activating event was
  • However, some cases aren't traceable of how people became depressed, known as endogenous depression
  • Therefore, Ellis's model can only explain some cases of depression
• How is OCD described as Polygenic

  • OCD is caused by a combination of genes, not just one, that increase the vulnerability
  • Taylor 2013 analysed and found evidence of 230 different genes involved in OCD, which affect rates of Dopamine and Serotonin
• What is the explanation of different types of OCD

  • One group of genes may cause someone to have a different type of OCD to another - known as aetiologically heterogeneous
  • This means the origins of OCD vary from people to people
• How does Serotonin affect OCD

  • Serotonin is a neurotransmitter which regulates mood
  • Neurotransmitters relay info from one neuron to another
  • If there are low levels of serotonin, then people experience a low mood
• How does Decision-Making systems affect OCD

  • Some cases of OCD are associated with the abnormal functioning of the frontal lobes
  • The frontal lobes are at the front part of the brain, the part which makes logical decisions
  • The parahippocampal gyrus which is associated with bad emotions functions abnormally in OCD too
• What is one strength of the genetic explanation of OCD?

  -It has good research support where people are vulnerable to OCD as their genetic makeup

  -Identical twins studied by Nestadt found that they were mure successpetible to OCD 68%, compared to 31% from non-identical twins

  -Research had also found that family members with OCD are 4 times as likely to develop it as someone without (Marini and Stebnicki 2012)
• What is one limitation of the genetic explanation of OCD

  • One limitation is that there are environmental factors that need to be discussed for OCD
  • It is seen that environmental factors can also increase the vulnerability of someone having OCD
  • Eg - Cromer 2007 found that over half the OCD clients had experienced traumatic events, with OCD being more severe in those with more than one traumas
  • Therefore, genetic vulnerability only partly explains OCD
• How do SSRI's treat OCD (Selecitve Serotonin Reuptake Inhibitor)

  • SSRI's work on the Serotonin
  • Serotonin is released by the presynaptic neurons and travels across a synapse
  • The Neurotransmitter travels from the presynaptic neuron to the postsynaptic neuron, where it is reabsorbed by the presynaptic where it is broken down and used
  • SSRI's effectively increase the levels of Serotonin in the synapse and then stimulate the postsynaptic neuron
• What are alternatives for SSRI's?

  • Tricyclics = An older type of antidepressant which acts on various systems including the serotonin system which has the same effect as SSRIs. Used for people who cannot use SSRI's as it has severe side effects
  • SNRI's = Serotonin-nonadrenaline reuptake inhibitors, different class of antidepressant which are used like tricyclics, only used when person doesn't respond to SSRI's
• One strength of Biological Treatments for OCD

  • One strength is that there is good evidence for effectiveness
  • There is evidence that SSRI's reduce symptoms of OCD
  • Soomro 2009 reviewed 17 studies of SSRI's in comparison to placebos, and found that all 17 had significantly improved, with symptoms reducing by 70%
  • Therefore, drug therapy is useful for treating OCD
• Another strength of Biological Treatments

  • Another strength of Biological Treatments is that it is cost effective
  • Thousands of SSRI's can be manufactred in the time that it takes for a psychological session takes
  • Therefore, it is better for institutions such as the NHS as it relieves them of stress and having to employ more workers
  • This means drugs are popular with many people with OCD and their doctors