psychothology

• abnormality - deviation from ideal mental health

  Jodah

  G- goal orientated

  R- resilience to stress

  Autonomy (independence)

  P- perception of reality

  E- master of environment

  S- self actualise

  • S: comprehensive definition: checklist to assess ourselves + others - application
  • W: culture-bound: self-actualise, self—indulgent in cultures, high indepenfence good in germany, bad in italy
  • W: ‘ideal’ mental health impossible to maintain all the time HOWEVER practical value to someone wanting to improve mental health
• abnormality - deviation from social norms

  social norms: collective judgement as a society, specific to a culture - difficult to globalise

  
  

  • S: application: antisocial personality disorder defined by failure to conform to social norms + schizotyal perosnailty disorter uses ‘strange’ to characterise thinking
  • W: cultural + situational relativism: hearing voiced + being decietful normal in some cultures/ situation but not all
  • W: human rights abuse: nymphomania used to control women HOWEVER need deviation for specific diagnosis
• abnormality - statistical infrequency

  how often you come across it (unusual = abnormal)

  68% score 100 IQ (normal), 2% score below 70 - abnormal + diagnosis of intellectual disability disorder

  • S: application: Beck’s depression inventory - score of 30+ = depression
  • W: abnormality can be good - 2% score above 120IQ but not abnormal - not a sufficient defintion
  • S: benefits: labelled as abnormal means support HOWEVER some don‘t benefit - social stigma
• abnormality - failure to function adequately

  failure to cope with everyday life

  Rosenham + Seligman:

  1. no conformity to standard interpersonal rules
  2. experience severe distress
  3. irrational/ dangerous

  behaviours: maladaptive + unpredictable etc

  • S: application: threshold for help (25% of UK have mental health problems) - seek help when failing to function - treatment targets most severe
  • W: label non-standard lifestyles as abnormal (travellers - no job, spiritualists - talk to dead)
  • W: unfair to label someone as abnormal if its temporary (reaction to bereavement) HOWEVER some still need help
• behavioural approach explaining phobias

  Mowrer’s 2-process model: gained through classical, maintained through operant

  Watson + Rayner‘s Little Albert: white rat + loud noise = phobia

  avoiding stimulus = reinforcing

  • S: application: avoidance maintains, exposure cures (SD + flooding)
  • S: link to phobias: De Jonah et al - 73% dental phobia experienced related trauma - control group only 21% HOWEVER not all phobias come from trauma + not all trauma leads to phobia
  • credible individual explanation HOWEVER general aspects better explained by evolutionary theory (fear of dark)
• treating phobias behavioural approach - systematic desensitisation

  counter-conditioning

  1. anxiety hierarchy - least to most
  2. relaxation - reciprocal inhibition (breathing techniques)
  3. exposure - least to most

  • S: Gilroy et al: 42 SD for arachnophobia - more relaxed than control group + Wechsler: SD good for specific, social and agoraphobia
  • S: learning disabilities struggle with cognitive + flooding therapy
  • S: virtual reality: cost effective + avoids danger (heights) HOWEVER Wechster et al: lacks realism
• treating phobias behavioural approach


  similar to SD - no build up - only 1 2-3 hour session

  no option of avoidance - learn quickly phobias is harmless

  extinction: learnt response extinguished

  relaxation achieved through exhaustion

  • S: cost-effective: 1 session vs 10 SD - clinically effective + cheap
  • W: traumatic: Schumacher et al - flooding rated more stressful than SD - ethical issues + high attrition rates HOWEVER informed consent achieved before hand
  • W: doesn’t tackle cause: Pearson case study: woman with phobia of death cured then developed phobia of being criticised
• explaining depression cognitive approach - Beck’s negative triad

  negative triad = negative view on: world, future, self

  cognitive vulnerability: faulty information processing, negative self-schema, negative triad

  • S: support: Clark + Beck - cognitive vulnerabilities proceed depression + Cohen at al: 473 particpants vulnerability measured - successfully predicted depression
  • S: application: Cohen - screening young people allows monitoring of risk + CBT
  • W: not fully developed: why do some feel extreme anger + experience hallucinations
• explaining depression cognitive approach - Ellis’s ABC

  Activating event triggers irrational beliefs

  Beliefs (irrational) - musturbation (perfection)

  Consequences - emotional/ behavioural

  • S: application: REBT - arguing changes beliefs + David et al: REBT changes beliefs and relieves symptoms
  • W: limited explanation: explaing reactive (traced to event) not endogenous (not traced to event)
  • W: ethics: places blame fully on depressed person HOWEVER if used appropriately, help achieve resilience + feel better
• treating depression contrive approach - CBT

  Becks cognitive therapy: identify irrational beleifs + challenge them

  Ellis’s REBT: adds DE - dispute (vigorous argument - empirical or logical) + effects (decreased avoidance)
• treating depression cognitive appporach - CBT evaluations

  • S: March et al: 327 adolescents, after 36 weeks: 81% CBT, 81% drugs, 86% both improved - just as effective as others HOWEVER effectiveness: severe cases unmotivated (HOWEVER Lewis + Lewis as effective as drugs + behavioural therapies) + Sturmey - any form of psychotherapy not good for learning disabilities -thinking (HOWEVER Taylor et al: if used appropriately, effective)
  • W: high relapse: Shehzad Ali et al - 439 people, 12 months of CBT - 42% relapse in 6 months, 53% a year
  • W: Yrondi et al: CBT least preferred psychological therapies
• explaining OCD - genetics

  faulty biological process - genetic vulnerability passed on

  Lewis: 37% parents with OCD, 21% siblings

  diathesis-stress model: certain genes leave you vulnerable to disorders (environmental stress triggers it) - candidate genes for OCD

  COMT: transmission of dopamine

  SERT: transmission of serotonin

  5HT1- D beta: transport serotonin accross synapses

  Taylor et al: OCD polygenic (cobimnation of genes) - 230 different genes for OCD

  aetiologically heterogeneous: origins vary for every person

  types of OCD result of particular genetic variations
• explaining OCD - genetic evaluations

  • S: support: Nestadt et al: 68% of identical twins share OCD, 31% non-identical + Marini+ Stebnicki: 4x more likely to have OCD if family member has it - sone genetic influence
  • W: environmental risk factor: environment triggers/ increases risk of OCD - Cromer et al: over 1/2 OCD people experienced trauma - OCD more severy with more trauma - genetic vulnerability only partial explanation
  • W: difficult to find candidate genes HOWEVER Ahmari: studied mice and found particular genes involved in repetitive behaviour HOWEVER generalisability to humans is poor
• explaining OCD -neural

  genes associated with OCD effect levels of neurotransmitters + structures of the brain

  1. serotonin (helps regulate mood) levels low
  2. transmission of mood relevant information doesn’t take place
  3. low mood + other mental processes

  abnormal functioning of frontal lobes= impaired decision making related to cases of hoarding

  left parahippocampal gyrus: processing unpleasant information functions abnormally with OCD
• explaining OCD - neural evaluations

  • S: support: reduced OCD symptoms + Nestadt et al: symptoms form parts of conditions biological in origin (Parkinsons) - assume it biological processes underline OCD - biological factors responsible for OCD
  • W: serotonin not unique to OCD, confounding variable of depression - serpentine irrelevant to OCD
  • W: correlation vs causality: correlation or neural abnormality + OCD not necessarily a relationship - OCD may cause abnormal brain function or a 3rd factor responsible
• treating OCD - drug therapy

  selective serotonin reuptake inhibitors: prevent reabsorption + breakdown of serotonin, continues to stimulate postsynaptic neuron, more likelt ST binds to receptor

  dosage varies with type

  3-4 months daily use for an impact - no response: dosage increased of paired with other drugs (tricyclics or SNRIs)

  combining SSRIs with other treatments: CBT (engage more effectively) or other drugs
• treating OCD - drug therapy evaluations 1

  • S: effectiveness: Soomro et al - 17 studies compare SSRIs + placebo, 70% symptoms improve (30% improved with drugs/therapies) - drugs appear helpful HOWEVER not the most effective: Skapinakis et al - CBT therapies better - drugs not optimum
  • cost effective + non-disruptive: good use of limited NHS funds - take drugs until symptoms decline vs time in therapy
• treating OCD - drug therapy evaluations 2

  • W: side effects: tricyclic domipromine - 1/10 erection problems + weight gain 1/100 aggressive + heart problems - low quality of life - attrition rates
  • W: biased evidence: Goldacre - researchers sponsored by drug therapies + lack of independent studies HOWEVER best available evidence supports effectiveness
• depression characteristics

  behavioural: activity levels, disruption to sleep + eating, aggression + self-harm

  emotional: lowered mood, anger, lowered self-esteem

  cognitive: poor concentration, dwelling on negative, absolute thinking

  main types of depression: major depressive disorder, persistent depressive disorder, disruptive mood dysregulation, premenstral dysphoric disorder
• OCD characteristics

  behavioural: compulsions are repetitive, compulsions reduce anxiety, avoidance

  emotional: anxiety + distress, accompanying depression, guilt + disgust

  cognitve: obsessive thought (90% of patients), cognitive coping strategies (appear abnormal), insight into excessive anxiety (aware its irrational)

  main types: OCD, trichotillommania, hoarding disorder, excoriation disorder
• phobia characteristics

  behavioural: panic, avoidance, endurance

  emotional: anxiety, fear, unreasonable

  cognitive: selective attention to stimulus, irrational beliefs, cognitive distortions (perceptions unrealistic)

  main types: specific phobia, social phobia, agoraphobia