Psychopathology revision notes

Psychopathology Revision PowerPoint

Definitions of abnormality: Statistical deviation Abnormality- behavior that is numerically unusual or rare when

plotted on a standard distribution curve Abnormal behavior= behavior at either extreme end of the graph

Evaluation of Statistical Deviation

It doesn't’t distinguish between desirable and non-desirable behaviors e.g. IQ

Who can judge the boundary between ‘normal’ and ‘abnormal’ Cultural relativism- something that is statistically rare in one culture

could be considered normal in another

Definitions of abnormality: Deviation from social norms Societies have standards and norms (expected/ appropriate behavior

patterns e.g. queuing) This definition argues that a person who acts in a socially deviant

way/ breaks society’s standards= abnormal It is based on abnormal behavior being viewed as unpredictable and

causing the observer discomfort/ violates moral standards Abnormal thinking is irrational because it differs from common ways

of thought

Evaluation of Deviation from social norms Too dependent on context Depends on time and culture Deviance can be good e.g. not conforming to politically repressive

regimes

Strength- distinguishes desirable and non-desirable behavior & considers effect on others

Definitions of abnormality: Failure to function adequately Being unable to manage everyday life e.g. eating regularly Lack of functioning is abnormal if it causes distress to self/ others WHODAS used to provide a quantitative measure of functioning

Evaluation of Failure to function adequately Distress may be judged subjectively Behavior may be functional- e.g. depression may be rewarding for the

individual Cultural relativism

Strength- recognised subjective experience of individual, can be measured objectively

Definitions of abnormality: Deviation from ideal mental health Jahoda identified characteristics commonly used when describing

competent people For example, high self-esteem, self-actualization, autononmy,

accurate perception of reality, mastery of the environment

Evaluation of Deviation from ideal mental health Unrealistic criteria- may not be useable because it is too ideal Views mental and physical health as the same thing- whereas mental

disorders tend not to have physical causes Positive approach- a general part of the humanistic approach

Mental disorders: Phobias

Emotional: excessive fear, anxiety/ panic cued by a specific object or situation

Behavioral: avoidance, faint or freeze. Interferes with everyday life. Cognitive: not helped by rational argument, unreasonableness of the

behavior is recognised

Mental disorders: Depression Emotional: negative emotions- sadness, loss of interest, anger Behavioral: reduced or increased activity related to energy levels,

sleep or eating Cognitive: Irrational, negative thoughts and self-beliefs that are self-

fulfilling

Mental disorders OCD Emotional: anxiety and distress, awareness that this is excessive,

leading to shame Cognitive: recurrent, intrusive, uncontrollable thoughts (obsessions),

more than everyday worries Behavioral: compulsive behaviors to reduce obsessive thoughts, not

connected in a realistic way

The behavioral approach:Explaining phobias- Two-process modelThe Two-process model Classical conditioning- phobia acquired through association between

NS and UCR; NS becomes CS, producing fear Little Albert (Watson and Rayner)- developed a fear of a white rat which generalized into a fear of other white furry objects Operant conditioning- phobia maintained through negative

reinforcement (avoidance of fear) Social Learning- phobic behavior of others modelled

Evaluation of the Behavioral approach to explaining phobias Classical conditioning- people often report a specific incident but not

always, may only apply to some types of phobia (Sue et al) Diathesis-stress model- not everyone bitten by a dog develops a phobia

(di Nardo et al) may depend on having a genetic vulnerability for phobias Social Learning- fear response acquired through observing reaction to

buzzer (Bandura and Rosenthal)

Biological preparedness- phobias more likely with ancient fears, conditioning alone cant explain all phobias (Seligman)

Two-process model ignores cognitive factors- irrational thinking may explain social phobias, which are more successfully treated with cognitive methods (Engels et al)

The behavioral approach to treating phobias: Systematic Desensitization Counterconditioning- phobic stimulus associated with new response

of relaxation Reciprocal inhibition- the relaxation inhibits the anxiety Relaxation- deep breathing, focus on peaceful scene, progressive

muscle relaxation Desensitization hierarchy- from least to most fearful, relaxation

practiced at every step

Evaluation of SD

Effectiveness- 75% success (McGrath et al), in vivo techniques may work better or a combination (Comer)

Not for all phobias- work less well for ‘ancient fears’ (Ohmen et al)

Strength- behavioral therapies are fast and require less effort than CBT, can be self-administered

The behavioral approach to treating phobias: Flooding One long session with the most fearful stimulus Continues until anxiety subsides and relaxation is complete Can be in vivo or virtual reality

Evaluation of flooding

Individual differences- traumatic, and if patients quit it has failed as a treatment

Effectiveness- research suggests it may be more effective than SD and quicker (Choy et al)

Relaxation may not be necessary- creating a new expectation of copying may matter more (Klein et al)

Symptom substitution- a phobia may be a symptom of an underlying problem (e.g. Little Hans)

The cognitive approach:Explaining DepressionEllis’ ABC Model (1962) Activating event leads to rational or irrational belief, which then leads

to consequences Mustabatory thinking (e.g. I must be liked)- causes disappointment

and depression Beck’s negative triad (1967) Negative schema- develops in childhood (e.g. parental rejection),

leads to cognitive biases Negative triad- irrational and negative view of self, the world and the

future

Evaluation of the cognitive approach to explaining depression Support for the role of irrational thinking- depressed people make more

errors in logic (Hammen and Krantz); however, irrational thinking may not cause depression

Blames the client and ignores situational factors- recovery may depend on recognizing environmental factors

Practical applications to CBT- supports the role of irrational thinking in depression

Irrational beliefs may be realistic- depressed people may be realists (Alloy and Abrahamson)

Alternative explanation- genes may cause low levels of serotonin, predisposing people to develop depression

The cognitive approach: Treating DepressionCognitive Behavioral Therapy (CBT) Ellis’ ABCDEF model D is for disputing irrational beliefs, e.g. logical, empirical, pragmatic E and F for effects of disputing and Feelings that are produced Homework- trying out new behaviors to test irrational beliefs Behavioral activation- encouraging, re-engagement with pleasurable

activities Unconditional positive regard- reduces sense of worthlessness

Evaluation of the cognitive approach to treating depression Research support- generally successful, Ellis estimated 90% success over

27 sessions. May depend on therapist competence (Kuyken and Tsivrikos). Individual differences- CBT not suitable for those with rigid irrational

beliefs, those whose stressors can not be changed and those who don’t want direct advice

Behavioral activation- depressed clients in an exercise group had lower relapse after 6 months (Babyak et al)

Alternative treatments- drug therapy is much easier in time and effort, can be used along side CBT

Dodo bird effect- all treatments equally effective because they share features, e.g. talking to a sympathetic person (Rosenzweig)

The biological approach: Explaining OCDGenetic Explanations COMPT gene- one allele more common in OCD, creates high levels of dopamine

(Tukel et al) SERT gene- one allele more common in a family with OCD, creates low levels of

serotonin (Ozaki et al) Diathesis-stress- same genes linked to other disorders or no disorder at all, therefore

genes create a vulnerability Neural Explanations Dopamine levels high in OCD- linked to compulsive behavior in animal studies

(Szechtman et al) Serotonin levels low in OCD- antidepressants that increase serotonin most effective Worry circuit- damaged caudate nucleus doesn’t suppress worry signals from the OFC

to thalamus Serotonin and dopamine linked to activity in these parts of the frontal lobe

Evaluation of the biological approach to explaining OCD Studies of first- degree relatives- 5 times greater risk of OCD if relative has OCD

(Nestadt et al) Twin studies- twice as likely to have OCD if MZ twins (Billett et al) Environmental component- concordance rates never 100%, type of OCD is not inherited Genes are not specific to OCD- also linked to Tourette’s, autism, anorexia i.e. obsessive-

type behavior Research support for genes and OFC- OCD patients and family members (genetic link)

more likely to have reduced grey matter in OFC (Menzies et al)

Real world application- genes may be blocked or modified, genetic explanations lull people into thinking there are simple solutions

Alternative explanations- relevance of two-process model supported by success of SD-like therapy called ERP (Albucher et al)

The biological approach:Treating OCDDrug Therapy Antidepressants increase serotonin SSRIs- prevent the reuptake of serotonin by pre-synaptic neuron Tricyclic’s- block re-uptake noradrenaline and serotonin but have

more severe side effects, so are second choice treatment Anti-anxiety drugs- BZs enhance GABA, a neurotransmitter that slows

down the nervous system D-Cycloserine- reduces anxiety (Kushner et al)

Evaluation of the biological approach to treating OCD Effectiveness- SSRIs better than placebo over short term Drug therapies are preferred- less time and effort than CBT, and may

benefit from interaction with a caring doctor Side effects- not so severe with SSRIs (e.g. insomnia), more severe

with tricyclic’s (e.g. hallucination) and BZs (e.g. addiction)

Not a lasting cure- patients relapse when treatment stops, CBT may be preferable

Publication bias- more studies with positive results published which may bias doctor preferences