psychopathology summary pt.2 (The cognitive approach (Explaining…
psychopathology summary pt.2
The cognitive approach
Ellis' ABC model
Activating event leads to rational or irrational belief which then leads to consequences
Mustabatory thinking (e.g. parental rejection), leads to cognitive biases
Beck's Negative Triad (1967)
Negative schema - develops childhood (e.g. parental rejection) , leads to cognitive biases.
Negative triad - irrational and negative view of self, the world and the future
Support for 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 recognising environmental factors
Practical applications to CBT - supports the role of irrational thoughts in depression
Irrational beliefs may be realistic - depressed people may be realists, sadder but wiser (Alloy and Abrahamson).
Alternative explanation - genes may cause low levels of serotonin, predisposing people to develop depression
Ellis' ABCDEF model
D 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 behaviours to test irrational beliefs
Behavioural activation - encouraging re-engagement with pleasurable activities
Unconditional positive regard - reduces sense of worthlessness (Ellis).
Research support - generally successful. Ellis estimated 90% success over 27 sessions
Individual differences - CBT not suitable for those with rigid irrational beliefs. those whose stressors cannot be changed and those who don't want direct advice
Behavioural activation - depressed clients in an executive group had lower relapse after 6 months - (Babyak et al.).
Alternative treatments - drug therapy is much easier in time and effort, and can be used with CBT.
Dodo bird effect - all treatments equally effective because they share features, e.g. talking to a sympathetic person (Rosenzweig).
The biological approach
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
Dopamine levels high in OCD - linked to compulsive behaviours in animal studies (Szrchtan et al.).
Serotonin levels low in OCD - antidepressants that increase serotonin most effective (Jenicke).
Worry circuit - damaged caudate nucleus doesn't suppress worry signals from OFC to thalamus
Serotonin and dopamine linked to activity in these activity in these parts of the frontal lobe (e.g. Sukel).
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 (Billet 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 behaviour
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.).
Antidepressants increase serotonin
SSRI's - prevent re-uptake of serotonin pre-synpatic neuron
Tricyclics - block re-uptake of 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.).
Effectiveness - SSRI's better than placebo over short term (Soomro et al.).
Drug therapies are preferred - less time and less effort than CBT, and may benefit from interaction with caring doctor.
Side effects - not so severe with SSRI's (e.g. insomnia), more severe with tricyclics (e.g. hallucinations) and BZs (e.g. addiction).
Not a lasting cure - patients relapse when treatment stops (Maina et al.). CBT may be preferable (Koran et al.).
Publication bias - more studies with positive results published which may bias doctor preferences (Turner et al.).