Psychopathology revision notes
- 2. 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
- 3. 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
- 4. 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
- 5. 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
- 6. 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
- 7. 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
- 8. 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
- 9. 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
- 10. 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
- 11. 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
- 12. 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
- 13. The behavioral approach: Explaining phobias- Two-process model The 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
- 14. 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)
- 15. 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
- 16. 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
- 17. 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
- 18. 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)
- 19. The cognitive approach: Explaining Depression Ellis’ 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
- 20. 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
- 21. The cognitive approach: Treating Depression Cognitive 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
- 22. 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)
- 23. The biological approach: Explaining OCD Genetic 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
- 24. 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)
- 25. The biological approach: Treating OCD Drug 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)
- 26. 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