Mental health-topic 3
Background-Behaviourist explanation
Background-cognitive explanation
Background-humanistic explanation
Applications
Cognitive behavioural therapy to treat depression: Cognitive-behavioural therapy is the most widely used form of talking therapy and it can be used to treat a range of anxiety disorders such as post traumatic stress disorder, depression and OCD, as well as psychotic disorders such as schizophrenia. CBT combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do).
Humanistic therapy to treat depression:Person centred counselling Person centred counselling is a humanistic approach that deals with the ways in whihc individuals percieve themselves rather than how a counsellor can interpret their unconscious thoughts or ideas. They prefer to refer to those in therapy as 'clients' rather than 'patients'. Person centred counselling can be used to treat depression
The core purpose of the person centred approach is to help improve the clients actualising tendency (the idea that all humans will persure what is best for them and develop towards their full potential). This type of therapy facilitates the personal growth and relationships of an individual by allowing them to explore and use their own strengths and personal identity.
Rogers suggested three core-conditions which facilitate clients and their personal growth:
1. Congruence-the counselllor must be completely open and genuine
2. Unconditional positive regard- the counsellow must be non-judgemental and postively value the client as a person in all aspects of their humanity
3.Empathy-the counsellor must strive to understand the clients experience and how they are feeling.
These core conditions are vital to helping an individual feel accepted and better understand their own feelings-essentially helping them to reconnect with their inner values and sense of self-worth. This reconnection with their inner resources enables them to find their own way to move forward.
There is no fixed number of sessions when using a person centred approach. this is normally determined between the counsellor and client. Some people attend for a short period, such as six sessions, others attend for a longer period depending on a persons needs and wishes
It involves helping patients to identify irrational and unhelpful thoughts and trying to change them. This involves showing patients links between their thinking, behaviour and emotion. The rationale for CBT is that our thoughts affect our feelings and behaviour, so by changing our thoughts and our behaviours we can make ourselves feel better. CBT teaches people with depression coping skills for dealing with different symptoms.
The aims of CBT in treating depression are:
- To re-establish previous levels of activity
- To re-establish a social life
- To challenge patterns of negative thinking
- To learn to spot the early signs of recurring depressions
During the sessions, the patient and therapist will work together to break down problems into their separate parts- such as thoughts, feelings and behaviours. The patient and therapist will analyse these areas to work out if they're unrealistic or unhelpful. The therapist will then be able to help the patient work out how to change unhelpful thoughts and behaviours.
After working out what the patient can change, the therapist will ask the patient to practise these changes in their daily life (possibly keep a diary) to be then discussed during the next session.
The eventual aim of therapy is to teach the patient to apply the skills they've learnt during treatment to their daily life. This should help manage their depression and stop it having a negative impact own their life-even after your course of treatment finishes. CBT usually takes place once a week, or a fortnight, for between 5 and 20 sessions. Each session will last 30-60 minutes.
Suggests that abnormal behaviour is learned in the same way any other behaviour is learned. This can occur throughout different types of learning, such as classical and operant conditioning.
Classical conditioning- this is where you learn through association. You tend to not realise this is happening at the time and the response you give is automatic. This is where an emotional response (e.g. fear, anxiety, happiness) becomes associated with a particular neutral stimulus (e.g. an animal, a place a smell). Watson & Rayner carried out an experiment, with Little Albert, that demonstrated that classical conditioning could be used to explain the development of phobias in humans.
At the start of the study Little Albert showed no fear of a white rat. In a series of trials, Little Albert was exposed to a sudden loud noise (striking a hammer against a metal bar) each time he was shown the white rat. Eventually, Little Albert only had to see the white rat and he demonstrated a fearful response (crying and crawling away). He had associated the feeling of fear with the white rat.
Operant conditioning- this is where you learn through reinforcement (positive and negative) and punishment. Positive reinforcement is when you receive a reward for a response which encourages you to do that behaviour again. Negative reinforcement is where you remove yourself from an unpleasant situation which again encourages you to do that behaviour again. Punishment stops you doing the behaviour again. This was researched by Thorndyke and Skinner who studied cats, rats and pigeons in boxes.
This process can be used to explain mental disorders such as addictions. For example, if someone tries gambling and is successful their gambling behaviour is reinforced. This may start as a voluntary behaviour but can become addictive. The player experiences a compulsive need to keep playing. One reason why gambling is so addictive is that is creates an intermittent schedule of reinforcement. This means that the gambler is not going to be rewarded every time they gamble (as they often will lose), so they keep gambling as they are constantly chasing their next win.
Operant conditioning can explain phobias by linking reward we get when we show a phobia or other disorder. People with depression caused by a traumatic event may receive attention and so be rewarded for showing signs of a disorder. However operant conditioning has a stronger role to play in the maintenance of anxiety disorders. Negative reinforcement is the removal of an aversive situation, so if someone with a phobia of lifts gets to a lift door and experiences anxiety so walks away and takes the stairs, the removal of the anxiety is a reward so they will repeat taking the stairs and so reinforcing their phobias of lifts.
In terms of social learning theory, behaviours such as depression can be seen in a child who has witnessed symptoms of depression. Children and teenagers will see many role models reacting to challenges in unhealthy, ineffective ways and will model what they see.
Treatments based on the behavioural model include:
1. Systematic desensitisation- this relies on relaxation techniques being taught to a person who gradually confronts their fear. The patient relearns the feeling of calmness and associates this with the phobic or anxiety-inducing stimulus,
2. Flooding- this is where the fear inducing stimulus is presented directly to the patient (e.g. a spider). The immediate fear response caused by adrenaline is not sustainable for long and eventually the person will calm down and then associate the feeling of calm with the object rather than fear.
3. Aversion therapy- is used to produce an unpleasant association such as nausea in adults with alcohol addiction. A drug is used that will result in a learned response of aversion to alcohol.
4. Reward/ reinforcement- by training parents to reinforce non-depressed behaviours in children and teenagers it can reduce depression
5. Behavioural therapy- based on role models and operant conditioning has also been shown to be effective with patients with schizophrenia.
Cognitive explanations of mental illness are concerned with faults in an individuals process of thinking, attention, reasoning and perception. This explanation suggests that mental disorders can be explained through examining irrational or maladaptive beliefs. Cognitive distortion is another term for irrational thinking. An individual can form an inaccurate perception of reality that may be highly negative or disturbed.
The primary researcher in this area is Beck (and later his student Burns). They suggest that some individuals display cognitive distortions (faults in thinking), which can lead to negative emotional and behavioural outcomes, such as depression and anxiety.
Examples of some cognitive distortions:
Filtering: We take the negative details and magnify them while filtering out all positive aspects.
Polarized thinking: Viewing things as either black or white. We have to be perfect or were a failure.
Overgeneralisation: Viewing one unfortunate event as part of a never-ending pattern of defeat.
Catastrophizing: Expecting a situation/outcome to be far worse than it actually is or will be. We expect disaster to strike, no matter what.
Personalization: Believing that everything others do or say us some kind of direct, personal reaction to you. We will also constantly compare ourselves to others
Beck suggests that these cognitive distortions come from childhood, as we acquire information about particular aspects of the world. This is known as schema development. Depression has been linked to a triad of negative schemas. (Negative views about the world to negative views about oneself and to negative vies about the future. The last two can affect each other.
When explaining depression, this theory suggests that early experience forms dysfunctional beliefs, which can then be triggered by a stressful/unpleasant life events (death of a loved one etc), which activate the underlying faulty beliefs/schemas. From then on, incoming information is processed with a negative bias, resulting in the emotional and behavioural symptoms of depression.
Psychotic disorders such as schizophrenia are less clear cut in terms of the cognitive explanation. Beck accepted the biological disposition caused by genes but that the concordance rates of less than 100% would be due to individual cognitive processes. There is a clear link between cognitive deficits and schizophrenia patients- these cognitive deficits can include intelligent, memory, attention and info-processing speed.
Treatments based on the cognitive explanation model aim to change the faulty cognitions of people with disorders by challenged negative beliefs and developing alternative thoughts and view about the world through a process of Cognitive behavioural therapy (CBT).
Humanistic psychology emerged during the 1950s as a reaction to the psychoanalysis and behaviourism that dominated psychology as the time. Humanist psychologists felt that both psychoanalysis and behaviourism were too pessimistic and deterministic. The humanistic perspective centres on the view that each person is unique and individual, and has the freewill to change at any time in his or her life. Humanistic perspective suggests that we are each responsible for our own happiness and wellbeing.
Humanistic psychologists emphasise the study of the whole person (holistic explanation) and believe that people are innately good and have a tendency to grow as individuals and fulfil their potential. They would suggest that mental disorders result from deviations from this natural tendency. When explaining mental illness, the humanistic approach believes that the classification of mental disorder is seen as unhelpful. They suggest that a persons symptoms can be better understood as the individual response to the blockage of growth. This explanation has led to developing new techniques and approaches to psychotherapy.
Humanism rejects scientific methodology (experiments), preferring qualitative research methods such as case studies, open ended questionnaires, unstructured interviews and unstructured observations.
An early humanistic theory was Maslow's hierarchy of needs. This is a motivational theory in psychology comprising a five tier model of human needs. Our most basic need is for physical survival, and this will be the first thing that motivates our behaviour. Once that level is fulfilled the next level up is what motivates us, and so on. However, anything that prevents this natural ability and need to grow will cause mental and social problems
In the field of mental health CARL RODGERS has been the most influential of the humanistic psychologists. He proposed that understanding healthy psychological development depends on several factors. These include:
The actualising tendency: Carl Rodgers believed that humans have one basic motive, that us the tendency to self actualize- i.e. to fulfil ones potential and achieve the highest level of 'human beingness' we can. People will grow to their full potential if the conditions are right, but is constrained by its environment, so people will flourish and reach their potential if their environment is good enough.
Rogers believed that people are inherently good and creative and guided towards values that will help them to thrive. They become destructive (e.g. symptoms of depression or anxiety) only when a poor self concept or external constraints interfere with the valuing process. Rogers believed that for a person to achieve self-actualisation they must be in a state of congruence.
The self-concept: Self concept is the image that we have of ourselves. it is generally thought of as our individual perceptions of our behaviour, abilities, and unique characteristics. Self concept is essentially a mental picture of who you are as a person. What can influence a persons idea of their actual self are conditions of worth. Self concept tends to be more flexible when people are younger and still going through the process of self-discovery and identify formation.
Rodgers believed that there were three different parts to self concept:
1. Self image or how you see yourself. It is important to realise that self image does not necessarily coincide with reality.
2. Self esteem or how much you value yourself. A number of factors can impact self-esteem, including how we compare ourselves to others and how others respond to us. When people respond positively to our behaviour, we are more likely to develop positive self esteem.
3. Ideal self or how you wish you could be. in many cases, the way we see ourselves and how we would like to see ourselves do not quite match up.
According to Rogers, the degree to which a persons self concept matches up to reality is known as congruence and incongruence. While we all tend to distort reality to a certain degree, congruence occurs when self-concept is fairly well aligned with reality. Incongruence happens when reality does not match up to our self concept.
Rogers believed that anyone imposing conditions for worth is wrong and we should all receive unconditional love (or, unconditional positive regard) particularly during childhood as this helps to promote congruence. Children who experience such love feel no need to continually distort their memories in order to believe that other people will love them and accept them as they are.
On the other hand, when parents place conditions on their affection for their children (only expressing love if children "earn it" through certain behaviours and living up to the parents' expectations), children begin to distort the memories of experience that leave them feeling unworthy of their parent's love. This promotes incongruence and can lead to low self esteem in adulthood, and such individuals are more vulnerable to mental disorder, especially depression.