KEY TERMS:
Statistical Infrequency:
Abnormality is any behaviour that is statistically infrequent in the population and falls outside of Statistical Norms.
Deviation from Social Norms:
Behaviour is abnormal if it goes against expected and approved of ways of behaving of society.
Failure to Function Adequately:
Behaviour is abnormal if it interferes with a person's ability to cope with everyday demands.
Deviation from Ideal Mental Health:
Abnormality is defined as the absence of the positive features of ideal mental health.
Cultural Relativism:
An individual's beliefs and activities should be understood by others in terms of that individual's own culture.
Autonomy:
Ability to be independent and self-reliant.
Phobias:
A phobia is a persistent, irrational fear of an object or situation. Phobias are a type of anxiety disorder.
There are 3 categories of phobias:
There are 3 categories of phobias:
- Specific phobia (EG: spiders, moths, heights, flying, needles etc.)
- Social phobia (Fear of social situations EG: eating in public, public speaking etc.)
- Agoraphobia (Fear of places or situations where escape might be difficult EG: away from home, in a crowded place, public place etc.)
Anxiety Disorder:
Agoraphobia:
Fear of places or situations where escape might be difficult EG: away from home, in a crowded place, public place etc.
Depression:
A mood disorder which causes severe, frequent and long-lasting feelings of low mood.
Depression is classified as a mood disorder, sometimes called major or unipolar depression, to distinguish it from other, similar disorders. It is one of the more common mental illnesses, with approx. 10% of the population experiencing it at some point in their lives. It differs from normal, everyday feelings of low moodonly by degree - depression is more severe, frequent and long-lasting. In sever cases, risk of suicide is significantly increased and so therefore it is a serious condition.
Depression is classified as a mood disorder, sometimes called major or unipolar depression, to distinguish it from other, similar disorders. It is one of the more common mental illnesses, with approx. 10% of the population experiencing it at some point in their lives. It differs from normal, everyday feelings of low moodonly by degree - depression is more severe, frequent and long-lasting. In sever cases, risk of suicide is significantly increased and so therefore it is a serious condition.
Mood Disorder:
Insomnia:
Difficulty sleeping/staying asleep
Hypersomnia:
Excessive sleep
Obsessive-Compulsive Disorder (OCD):
OCD is classified as an Anxiety Disorder. The indiviual experiences unwanted and repetitive thoughts/feelings/ideas/sensations (known as obsessions), and/or behaviours that make them feel driven to do something (known as compulsions)
Obsessions:
Unwanted and repetitive thoughts/feelings/ideas/sensations
Compulsions:
Behaviors that make them feel driven to do something
The OCD Cycle:
Hypervigilance:
Heightened senses, over-alert
Ritualistic:
Actions must be performed a certain way, or a specific number of times
The TWO-PROCESS MODEL:
Stage 1: Classical Conditioning - Initiation of the Phobia:
A person who is not afraid of dogs is one day attacked and severely bitten by a dog. The person develops a phobia of all dogs.
What could have occurred in this situation for the person to develop a phobia?
Before conditioning: NS (dog) - no response
UCS (pain) - UCS (fear)
During conditioning: NS (dog) + UCS (pain) - UCR (fear)
After conditioning: CS (dog) - CR (fear)
Stage 2: Operant Conditioning - Maintenance of the Phobia:
- Classical Conditioning is learning through association. It involves pairing a response naturally caused by one stimulus with another, previously neutral, stimulus.
- Phobias are caused when a neutral stimulus, NS (ie: one that does not provoke fear) becomes associated with a frightening unconditioned stimulus,UCS (ie: one that provokes a reflex, unconditioned fear response, UCR). The neutral stimulus becomes a conditioned stimulus, CS, and fear of it becomes a conditioned response, CR.
A person who is not afraid of dogs is one day attacked and severely bitten by a dog. The person develops a phobia of all dogs.
What could have occurred in this situation for the person to develop a phobia?
Before conditioning: NS (dog) - no response
UCS (pain) - UCS (fear)
During conditioning: NS (dog) + UCS (pain) - UCR (fear)
After conditioning: CS (dog) - CR (fear)
Stage 2: Operant Conditioning - Maintenance of the Phobia:
- Responses learned via classical conditioning tend to fade over time (a process called extinction), yet one feature of phobias is their persistence over time.
- Mowrer proposed that this can be explained by Operant Conditioning. Avoidance of the phobic stimulus is negatively reinforced (EG: the dog phobic goes out of their way to avoid situations where they might encounter a dog). This is negative reinforcement because the unpleasant consequence (fear) is successfully avoided by behaving in this way.
- This strengthens and maintains the avoidance behaviour (ie: because it is successful at avoiding and reducing fear and anxiety, it will be repeated)
- This maintains the phobia, because the person is avoiding situations in which they might encounter dogs without a frightening experience, which would tend to extinguish the phobia..
Systematic Desensitisation:
- Based on classical conditioning.
- Aims to extinguish (ie: unlearn) a fear response by replacing it with a more desirable, incompatible response (relaxation).
- Used to treat phobias, by exposing the client to the threatening situation under relaxed conditions, until anxiety is extinguished.
- Can be carried out in vivo (actual reality), virtual reality, or by using imagination alone.
- Therapist and client construct a hierarchy of fear - working up from least frightening to most frightening stimulus.
- Client is given training in deep muscle relaxation techniques and taught breathing exercises/meditation/told to imagine themselves somewhere relaxing to help them relax.
- Client is exposed to the phobic stimulus, using relaxation techniques at each stage of the hierarchy.
- Therapy starts with least feared situation which only progresses to the next stage once the client feels relaxed enough to do so. Gradually, they are exposed to their whole hierarchy of feared situations.
- The client can eventually remain calm when confronted with their phobic object/situation.
Flooding:
- Based on classical conditioning.
- Aims to learn a relaxation response, which will then extinguish and replace the fear response.
- Can be carried out in vivo (actual reality), virtual reality, or by using imagination alone.
- Alternative to the gradual exposure used in Systematic Desensitisation.
- Identify the worst possible case scenario, rather than creating a hierarchy of fear (SD).
- Client is taught relaxation techniques (like in SD) to use if needed to help them relax.
- The client is exposed to their most feared situation for a prolonged period of time, without the option of escape.
- Eventually the fear begins to subside partly due to the use of relaxation techniques; and also because there is a time limit to the body's fear response, as adrenaline levels naturally decrease overtime (2-3 hours).
- The patient replaces the fear response with a calm, relaxed response to the phobic stimulus.
Hierarchy of Fear:
Effectiveness:
Appropriateness:
Beck's Negative Triad:
BECK (1967) claimed that negative schemas can develop in response to unhappy childhood experiences such as rejection or criticism. These negative schemas create systematic cognitive biases which result in everything being viewed in a negative light. Common examples include:
- Overgeneralisation - Making general conclusions based on single negative events EG: "I can't cook", based on one burnt cake.
- Magnification - Exaggerating small problems into far larger ones.
- SELF - "I'm worthless"
- WORLD - "Nothing good happens to me" or "Nobody likes me"
- FUTURE - "Nothing's ever going to get better"
Overgeneralisation:
Making general conclusions based on single negative events EG: "I can't cook", based on one burnt cake.
Magnification:
Exaggerating small problems into far larger ones.
Pessimistic:
Ellis's ABC Model:
ELLIS (1962) believed that people with depression mistakenly blame external events for their illness. He believed it was their interpretation of these events that was to blame for their depression.He developed the ABC model to explain the process. The model can be described as "as I think, so I feel (and do)!"
Non-depressed people may react completely differently to an activating event, such as failing mock exams, believing that they did their best. The consequent emotion here might be to be motivated to do better. The difference between depressed and non-depressed individuals, then, is self-perception.
- A - Activating Event EG: fail mock exam leads to...
- B - Beliefs about the Event EG: I can't do exams, leads to...
- C - Consequence EG: leave college, or get depressed.
Non-depressed people may react completely differently to an activating event, such as failing mock exams, believing that they did their best. The consequent emotion here might be to be motivated to do better. The difference between depressed and non-depressed individuals, then, is self-perception.
Cognitive Behaviour Therapy (CBT):
Based on the assumption that depression is caused by the way the patient views themselves and the world. It is therefore assumed that working with the client to teach them to identify maladaptive thought processes and beliefs, and to replace these with more adaptive thoughts and beliefs, will reduce emotional distress and depression.
Rational Emotional Behaviour Therapy (REBT):
REBT is a type of CBT, developed by Ellis (who also devised the ABC model). CBT works using a variation of Ellis's ABC Model, known as THE ABCDE MODEL: In response to the activating event (A), the client is taught to challenge the abnormal, self defeating beliefs (B), which lead to unhealthy, emotional and behavioural consequences (C). This is done by disputing (D) the self-defeating beliefs (B), which then leads to positive effects (E).
Logical Disputing:
Challenging irrational beliefs that do not follow logically from the information available (EG: does thinking this way make sense?)
Empirical Disputing:
Identifying when self-defeating beliefs are not consistent with reality/the evidence (EG: where is the proof that this belief is accurate?)
Pragmatic Disputing:
Emphasises the lack of usefulness in self-defeating beliefs (EG: how likely is it that this belief will help me?)
Behavioural Activation:
Encouraging the depressed person to engage in enjoyable activities.
Candidate Genes:
Specific genes that influence vulnerability to OCD and influence neural activity and brain structure.
Diathesis-Stress:
Genes can cause a biological vulnerability (diathesis), but other factors, such as life experiences (stress), affect whether OCD actually develops.
Selective Serotonin Reuptake Inhibitors (SSRI):
Chemicals that block the reabsorption of serotonin in the pre-synaptic cell and therefore increase levels of available serotonin in the synapse. This enables continued stimulation of the post-synaptic neuron. One example of an SSRI is fluoxetine (Prozac)
Tricyclic Antidepressants:
And older generation of antidepressants that work in the same way as SSRIs and blocks the reuptake of both serotonin and noradrenaline. A common example of a tricyclic antidepressant is clomipramine.
KEY PSYCHOLOGISTS:
JAHODA (1958):
MOWRER (1960):
WATSON & RAYNER (1920):
WATSON & RAYNER (1920) conducted an experiment on an 11 month old boy known as Little Albert, a calm child with no fears at the start of the study. They attempted to condition a phobia of rats by presenting Albert with a rat. When he reached for it they struck a steel bar behind his head to make a loud noise. They repeated this 3 times and did the same a week later. After this, when they showed the rat to Albert, he began to cry. They had conditioned a fear response in him using classical conditioning.
DINARDO et al (1988):
DINARDO et al (1988) found that 60% of dog phobics could recall a frightening experience with a dog, supporting the behavioural approach, in a control group of participants without a phobia of dogs, the same percentage reported a frightening experience of dogs!
SELIGMAN (1970):
SELIGMAN (1970) proposed that the two-process model was incorrect in its force on learning as the sole factor causing phobias. Seligman believed that evolutionary factors are also important: we are genetically 'primed' to quickly learn to fear objects and situations that were life threatening to our distant ancestors. Modern day threats haven't had time for us to evolve this response, hence phobias of cars etc. are rare.
McGRATH et al (1990):
McGRATH et al (1990) found that 75% of patients with phobias respond to SD.
CAPAFONS (1998):
CAPAFONS (1998) found that when used with aerophobics, those who had undergone SD reported lower levels of fear and lower physiological signs of fear during a flight simulation. This shows that both perception of fear and bodily fear response are effectively reduced.
GILROY et al (2003):
GILROY et al (2003) found that spider phobics were still less fearful than a control group, who had only experienced relaxation training, 33 months later. This also shows that SD's effectiveness is not solely based on the relaxation element, but that the exposure element also contributes significantly to the reduction of fear.
WOLPE (1960):
WOLPE (1960) treated an adolescent girl with agoraphobia by putting her into the back of a car and driving her around for 4 hours. Her fear initially rose to hysterical panic, but then receded. By the end of the journey, she was completely calm.
WOLPE (1960) - this case study has no data on long-term effectiveness (was she permanently cured of her phobia?), therefore, we need more evidence before concluding that flooding is effective.
WOLPE (1960) - this case study has no data on long-term effectiveness (was she permanently cured of her phobia?), therefore, we need more evidence before concluding that flooding is effective.
CHOY et al (2007):
CHOY et al (2007) found flooding to be superior than SD.
SHIPLEY & BOUDEWYNS (1980):
SHIPLEY & BOUDEWYNS (1980) found that only 0.2% of patients experienced side-effects: the same (or fewer than) alternative treatments. Therefore, it was concluded that flooding is safe, effective and appropriate for the majority of phobic patients.
CRASKE et al (2008):
CRASKE et al (2008) found no difference between flooding and SD.
BECK (1967):
BOURY et al (2001):
BOURY et al (2001) used Beck's depression inventory to monitor students' negative thoughts. They found that depressives misinterpret facts and experiences (negatively) and they feel hopeless about the future, providing support for Beck's cognitive explanation.
Temple-Wisconsin Study:
The Temple-Wisconsin Study is a longitudinal research study. This study measured students' thinking styles every few months. They found that 17% of students who scored high on tests of negative thinking went on to become depressed, compared to only 1% of those with low scores. This suggests that negative thinking precedes the onset of depression, so may play a casual role.
ELLIS (1962):
ELLIS believes that on average 27 sessions are needed to complete the treatment. It may be unsuitable as a treatment for individuals who are very rigid in their thinking, or who are unable/unwilling to engage in the hard work required.
CUIJPERS et al (2013):
CUIJPERS et al (2013) reviewed 75 studies concerning the outcome of treatment for depression and found that CBT was superior to no treatment. Interestingly, Cuijpers review also found that CBT was especially effective if combined with drug therapy.
DAVID et al (2008):
DAVID et al (2008) compared REBT, Beck's cognitive therapy and antidepressant drug therapy. All three were equally effective at the end of the treatment, however, at a 6-month follow-up, evidence suggested that REBT was more effective than the other two types of therapy.
KUYEN & TSIVRIKOS (2009):
KUYEN & TSIVRIKOS (2009) suggests that as much as 15% of the variance in outcome might be attributable to therapist competence.
RUHE et al (2007):
RUHE et al (2007) suggests that low levels serotonin result in depression.
DeRUBEIS et al (2008):
DeRUBEIS et al (2008) found that relapse rates are lower with CBT.
NESTADT et al (2000):
NESTADT et al (2000) found that first-degree relatives of an individual with OCD had an 11.7% probability of suffering from OCD, compared to only a 2.7% risk in a control group. This 5x increase in the incidence of OCD in close relatives is presumable due to shared genes.
MIGUEL et al (2005):
MIGUEL et al (2005) studied identical twins and found a concordance rate of between 53 to 87%.
TUKEL et al (2013):
TUKEL et al (2013) found that the COMT gene regulates activity of the neurotransmitter dopamine. One variation of the COMT gene, which results in higher levels of dopamine, is more common is people with OCD than in normal controls.
TAYLOR (2013):
TAYLOR (2013) provides further support for the role of genes, finding that as many as 230 genes may be involved in causing OCD. This supports the idea that OCD is polygenic ie: caused by multiple, rather than single, genes.
SZECHTMAN et al (1998):
SZECHTMAN et al (1998) found that drugs which increase dopamine activity produce repetitive, stereotyped movements in animals, which resemble the compulsive behaviours observed in OCD patients.
PIGOTT et al (1990):
PIGOTT et al (1990) found that drugs which increase serotonin activity decrease OCD symptoms. This both supports the role of neurotransmitters in OCD and provides evidence of useful, real life application of neural explanations.
SAXENA et al (1998):
SAXENA et al (1998) found that brain scans of patients with OCD support the suggestion that there are abnormally high levels of activity in the orbitofrontal cortex, caudate nucleus, thalamus and anterior cingulate gyrus. This shows that these brain structures play a role in OCD.
SOOMRO et al (2009):
SOOMRO et al (2009) reviewed 17 clinical trials which had compared SSRIs to a placebo. They found that, in all 17 studies, symptoms reduced significantly more with the SSRIs than for those who were given the placebo.
JENIKE et al (1990):
JENIKE et al (1990) found a larger reduction in OCD symptoms with clomipramine compared to fuoxetine.