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Psycho
Paper 1
pathology
Definitions of abnormality (Definitions in the field of mental health for Y12)
Statistical Infrequency AO1
This definition states abnormality is when an individual has a less common or rarer characteristic than most of the population. It uses numbers to define abnormality which means it is an objective measure. Abnormality is implied if the behaviour is more than two standard deviations away from the mean and therefore the behaviour is in the top or bottom 2% of the population.
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For example, the average IQ score is 100. The 2% of the population who score below 70 are considered abnormal and could be diagnosed with intellectual disability disorder. But those who are in the top 2% above 130 are also abnormal.
AO3
+ Objective & free from bias. Reliable measure as it is consistent between clinicians.
- Does not distinguish between desirable and undesirable behaviour e.g. a high IQ is still abnormal.
Deviation from Social Norms AO1
Society has certain established norms of behaviour, which provide expectations about how people ‘should’ behave. These norms are passed on through socialisation. Abnormality is implied if the behaviour is not within these established norms of a society.
An example is people who have antisocial personality disorder (formerly psychopathy) have a failure to conform to ‘lawful and culturally normative ethical behaviour’. Due to their lack of empathy, they tend to operate outside of cultural norms and can be considered abnormal due to this.
​AO3
+ Distinguishes between desirable and undesirable behaviour and helps to know when support is needed.
- It is not a consistent definition as it changes across time & culture e.g. same sex relationships.
Failure to Function Adequately AO1
Abnormality is judged as inability to cope with the demands of everyday living. Inability to function or cope has been defined by Rosenhan and Seligman (1989) using an objective list which includes the following items:
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Inability to go to work / go to school
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Failure to maintain basic hygiene
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Behaviour is maladaptive, irrational or dangerous
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Cannot manage own personal distress and anxiety
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Causes distress for others (observer discomfort)
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Causing themselves or others harm
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AO3
+ Both subjective (patient’s view considered) & objective (criteria). Comprehensive definition.
- Some people can appear to function but be severely disturbed e.g. Harold Shipman killed 250 of his patients.
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Deviation from Ideal Mental Health AO1
This is a positive definition as it defines abnormality as the absence of signs of good mental health.
Jahoda (1958) developed criteria for these ideals
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Accurate perception of reality
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Positive attitude to him/herself (good self-esteem and of lack guilt)
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Self-actualisation – ability to reach potential
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Resistance to stress
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Environmental mastery
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Be independent of other people (autonomy)
AO3
+ A positive definition. Gives patient’s something to aspire towards.
- Sets unrealistic expectations. Too high as most of society would be abnormal.
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Characteristics of disorders
There is no AO3 for this topic
Behavioural: Things people are doing
Emotional: Things people are feeling
Cognitive:​ Things people are thinking
Phobias
​Behavioural: Avoidance of the phobic stimuli and panic (physiological response in the body)
Emotional: Anxiety and fear
Cognitive:​ Cognitive distortions, irrational beliefs
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Depression​
Behavioural: Disrupted sleep (too much / little), disrupted eating (too much / little), reduced activity
Emotional: Extreme sadness, anger
Cognitive:​ Irrational beliefs, negative biases, poor concentration​
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OCD​
Behavioural: External compulsions (repetitive behaviours) in an attempt to stop the anxiety, avoidance
Emotional: Anxiety caused by the irrational thoughts, distress
Cognitive:​ Irrational beliefs, awareness of the irrationality but inability to stop the thoughts
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Behaviourist approach to explaining phobias
AO1​​
Mowrer (1960) used learning theory to propose the behavioural explanation of phobias through a two-process model:
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Phobias are acquired or initiated through classical conditioning (learning through association)
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Phobias are maintained or continued through operant conditioning (learning through consequences)
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​Initiation of a phobia​
According to the behavioural approach a phobia is acquired through learning an association. Being bitten (unconditioned stimulus) creates an automatic fear response (unconditioned response). But when a dog (neutral stimulus) is associated with being bitten (unconditoned stimulus) through pairing, the dog (now a conditioned stimulus) then produces a fear response (conditioned response) on its own.
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Before conditioning: UCS > UCR
During conditioning: UCS + NS > UCR
After conditioning: CS > CR
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Maintenance of a phobia
The maintenance of phobias can be explained through operant conditioning. Operant conditioning takes place when behaviour is reinforced i.e. the likelihood of a behaviour being repeated is increased if the outcome is rewarding.
A person avoids a feared object to reduce anxiety and is therefore rewarding. This is an example of negative reinforcement because a person avoids the situation to escape from the unpleasant feeling of fear. This consequence means the behaviour will be repeated.
Case study: Little Albert
The case study of Little Albert by Watson and Rayner (1920) is the most famous case of conditioning a phobic response. Little Albert was conditioned to associate the neutral stimulus of a white rat with a conditioned response of fear after the rat has been continuously paired with the unconditioned stimulus of a loud noise. This phobia was then generalised to other furry white objects. Little Albert showed anxiety when exposed to a fur coat, cotton wool and Watson wearing a Santa Claus beard.
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​​​​ AO3
+ Real world application - treatments of phobias
+ Case study evidence: Little Albert
- Too reductionist - does not consider cognitions e.g. social phobias
- Ignores evolutionary factors (Bounton, 2007)
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Behaviourist approach to treating phobias
AO1​​
The behavioural treatments assume that as phobias have been learnt, then patients can also unlearn the phobia. There are two techniques:
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Systematic desensitisation
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Flooding
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Systematic desensitisation
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The client and therapist will work together to design an anxiety hierarchy which is a list of least to most stressful scenarios in relation to the phobic stimuli.
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e.g. photo of a dog to stroking a dog in close proximity
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The client is then taught relaxation techniques by the therapist e.g. deep breathing​
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​The therapist helps the client to gradually work their way up the hierarchy while maintaining relaxation at each stage.
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The treatment works based on reciprocal inhibition which is the idea that fear and relaxation cannot co-exist. If the client becomes upset at any stage they can return to an earlier stage and regain their relaxed state.
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When the client has reached the top of the hierarchy the CS-CR link will have been replaced and the phobic stimuli will now create a response of relaxation, known as counter conditioning.
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Flooding​
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Flooding is an immediate and prolonged exposure technique whereby the client is put into a very frightening situation to prevent avoidance. For example, a patient with arachnophobia may be put into direct contact with a large spider.
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The patient quickly learns that the phobic stimulus is harmless. In some cases, the patient may achieve relaxation simply because they become exhausted. In classical conditioning terms this process is called extinction.
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Flooding sessions are typically longer than systematic desensitisation, with one session usually lasting two to three hours. Sometimes only one long session is needed to cure a phobia.
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​​​​​​​​​​​​​​​​​ AO3
+ SD is effective (Gilroy 2003) 42 ppt with spider phobia
+ SD suitable for diverse ppt
+ Flooding is cost effective - NHS
- High attrition rates flooding
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Cognitive approach to explaining depression
AO1​​
The cognitive approach suggests psychological disorders such as depression are a result of faulty or irrational thinking. There are two main cognitive explanations; Beck and Ellis.
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Beck
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Beck argued that people with depression have faulty information processing.
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He said they focus on the negative aspects of a situation e.g. glass half empty rather than full.
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He argues people with depression form negative schemas (mental representations of knowledge) about themselves, the world and the future known as the negative triad.
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He argued these negative schemas are formed in childhood and provide a negative framework for interpreting events pessimistically.
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As people then view the world through these negative schemas it can lead to a cycle of automatic negative thinking, lowering mood and maintaining depression.
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Other examples of faulty information processing include:
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Overgeneralisation: Making sweeping conclusions based on one single event e.g. receiving one bad test result and thinking you are a failure.
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Absolutist thinking: An all-or-nothing approach to viewing the world. e.g. believing something is perfect or awful with no in-betweens
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Ellis
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Ellis argued that depression is caused by irrational thinking. He said this is any type of thinking that interfere with our happiness or cause us pain.
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His model of depression focuses on a reaction to a negative event. He developed the ABC model to explain how people can react differently to negative events which cause stress and adversity which can lead to depression.
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The model provides a sequential process:
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A – Activating event to which there is a reaction
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B – The belief about why the situation occurred. This can be rational or irrational.
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C – The consequence of the feelings and behaviour the belief now causes
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Ellis argues that the source of irrational beliefs lies in mustabatory thinking which is thinking that certain assumptions must be true in order for an individual to be happy.
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Ellis identified the three most important irrational beliefs:
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I must be approved of or accepted by people I find important
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I must do well or very well, or I am worthless
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Other people must treat me fairly and kindl
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​​​​ AO3
+ Grazzioli & Terry (2007) - 65 pregnant women
+ Real life application to CBT / REBT
- Reductionist - ignores biology
- Blames the client and ignores situation
- Ellis' model can only explain reactive depression
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Cognitive approach to treating depression
AO1​​
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Cognitive Behavioural Therapy (CBT) is the most commonly used treatment in the NHS for depression.
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The cognitive element of CBT aims to identify irrational thoughts and replace them with more rational ones.
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The behavioural element of CBT aims to encourage behaviours which could help a person improve their symptoms e.g. meet a friend for a coffee, take a walk.
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There are two models of CBT (on the specification) but they have commonalities.
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Clients are treated as scientists who test their beliefs and gather evidence for and against their thoughts.
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Homework is a key component, for example completing thought diaries or behavioural experiments to practice skills between sessions.
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The focus is on present thinking, as both approaches argue that it is current irrational/negative thought patterns that cause distress.
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Therapy is collaborative, with therapist and client working together to explore and change unhelpful beliefs rather than the therapist imposing answers.​
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Beck
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​Aim is to identify and challenge the automatic thoughts about the world, self and future.
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Through gentle socratic questioning (guided, open-ended questions) that a therapist asks, it helps clients discover the truth of their thoughts for themselves.
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Through collaboration with the therapist the client can change their negative schemas.
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Ellis' Rational Emotive Behavioural Therapy (REBT)
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Ellis extended his ABC model and added three stages DEF for treatment.
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Dispute: The therapist asks the client to dispute/ challenge their irrational thoughts and beliefs. This is more vigorous than Beck’s socratic questioning.
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Effective new responses: The therapist asks the client to think of more rational responses.
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Feelings: The client is asked how this new rational outlook would make them feel, which can change behaviour.
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Types of diputing include:​
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Empirical disputing – assessing whether there is evidence for the thought e.g. “What evidence do you have that you’re a complete failure?”
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Logical disputing – assessing whether the thoughts follow from the facts e.g. “Does one mistake logically mean you’re a worthless person?”
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Pragmatic disputing – assessing if the thought is helpful? E.g. “How is this belief helping you reach your goals or feel better?”
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​​​​ AO3
+/- March (2007) 81% CBT, 86% CBT and drug therapy
- Relies on being motivation but symptom is avolition
- Too focused on thinking and not clients environment
- Not suitable if deep rooted childhood trauma
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Biological approach to explaining OCD
​AO1
Genetic explanation
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The genetic explanation suggests that people inherit a genetic vulnerability to OCD through DNA from parents. OCD is likely to be polygenic meaning that more than one gene is involved.
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There are 230 candidate genes but there are currently two main possibilities: COMT gene & SERT gene Both of these genes regulate levels of neurotransmitters in the brain.
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OCD is also aetiologically heterogeneous, meaning different combinations of genes cause different types of OCD in different people.
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If a person has a mutation of the COMT gene it causes low levels of the catchecol-o-methyltransferase (COMT) enzyme. This enzyme breaks down the neurotransmitter dopamine in the brain. Therefore, low levels of the enzyme means high levels of dopamine leading to compulsions and obsessions.
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If a person has a mutation of the SERT gene it causes high levels of a protein which removes serotonin. Therefore, high levels of the protein means low levels of serotonin leading to low mood and anxiety.
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The diathesis stress model suggests that certain genes create a vulnerability for a disorder but with a stressor the disorder will not develop.
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Neural explanations
Abnormal levels of neurotransmitters
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It is thought that people with OCD have low levels of the neurotransmitter serotonin. This means that the brain does not communicate information about mood effectively and is associated with the symptom of anxiety.
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It is thought that people with OCD have high levels of the neurotransmitter dopamine which is important for maintaining interest and motivation.
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Therefore, high levels of dopamine are associated with the symptoms of compulsions and obsessions in OCD.
The worry circuit
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The orbitofrontal cortex (OFC) is responsible for detecting potential threats and sending ‘worry’ signals to the thalamus.
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On the way to the thalamus the caudate nucleus (part of the basal ganglia) normally suppresses minor or irrelevant worry signals from the OFC. In individuals with OCD, the caudate is believed to function abnormally, meaning that unimportant signals are not suppressed.
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As a result, too many worry messages reach the thalamus, increasing anxiety and contributing to obsessive thoughts and compulsive behaviour. This cycle is known as the worry circuit
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​​​AO3 (for both topics)
+ Nedstadt (2010) concordance rates of 68% MZ / 31% DZ
- Cromer (2007) 1/2 of OCD ppts experienced trauma
+ SSRIs are effective at reducing symptoms (link to serotonin)
+ Menzies (2007) brain scans of OCD and family members - both had reduced grey matter
+ Biologically deterministic
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Biological approach to treating OCD
Drug therapies work by attempting to change the level or activity of neurotransmitters in the brain.
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Selective serotonin reuptake inhibitors (SSRIs)
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OCD is associated with low levels of the neurotransmitter serotonin. Selective serotonin reuptake inhibitors (SSRIs) are a first line treatment for OCD and are distributed under brand names of Prozac and Sertraline.
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They increase the levels of serotonin in the synapse by blocking the process of reuptake – the reabsorption into the presynaptic neuron. Serotonin will then continue to bind to the postsynaptic receptors, increasing serotonergic activity. This helps to regulate mood and anxiety.
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Typical doses will start at around 20mg and be increased systematically up to around 60 mg if there appears to be no effect. It can take 3-4 months for SSRIs to improve symptoms.
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Quite often drug therapies are used alongside CBT to treat OCD. The drugs might help a person be able to engage with CBT by helping reduce the emotional symptoms such as anxiety or depression.
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
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These are a 2nd line treatment.
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They work in the same way as SSRIs (by blocking the process of reuptake) but target two neurotransmitters, serotonin and noradrenaline. As they target two neurotransmitters, they have more side effects.
Anti-anxiety drugs
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Benzodiazepines e.g. Diazepam (brand name Valium) are anti-anxiety drugs which are commonly used to reduce anxiety. They work by increasing the activity of the neurotransmitter GABA which is an inhibitory neurotransmitter.
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GABA makes the post synaptic neuron less likely to fire an action potential as it creates a negative charge at the cell’s membrane, which reduces neuronal activity and has a calming effect on the nervous system. They do have potential for abuse and can be addictive. For this reason, they are usually only recommended for short-term or occasional use
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​​​​ AO3 (for both topics)
+ Soomro (2009) - 17 studies SSRIs - 70% effective
+ Cost effective and non disruptive
- Side effects e.g. vision, sex drive
- Publication bias due to funding from pharmaceuticals
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