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Psychopathology - Coggle Diagram
Psychopathology
OCD
Treatments
SSRI antidepressant
prozak
commonly used drug to reduce the anxiety with OCD
block the reuptake of serotonin in presynaptic membrane (increasing serotonin concentration at receptor sites on post synaptic membrane)
as low serotonin levels are implicated with worry circuit increasing serotonin may have the effect of normalising this circuit
Side effects: nausea, headache and insomnia
Tricyclic antidepressant
Anafranil
blocks transporter machanism that reabsorbs serotonin and noradrenaline into presynaoptic cells (cells that release them)
effect is to increase both serotonin and noradrenaline levels
they have more side effects than SSRIs so used as 2nd line treatment when SSRIs have no effect
Side effects: Dizziness, drowsiness, stomach upset, nausea, vomiting, changes in appetite/weight, flushing, sweating, tiredness and blurred vision
Benzodiazepine
anti anxiety drug (vallium)
used to treat OCD obviously
enhance activity of gamma-aminobutyric acid (GABBA), has general quieting effect on brain neurons
neurons acivity is slowed down and induces relaxation
Bzs react with GABBA receptors on receiving neuron making it harder for neuron to be stimulated by other nuerotransmitters by releasing chloride ions
Side effects: increased aggression, addictive (limited to max. 4 week treatment because of this) and long term memory impairment
Ao3
Evidence for drug effectiveness
Soomro et al reveiwed 17 studies of use of SSRIs with OCD patients and found they were more effective than the placebo at reducing symptoms of OCD (up to 3 months after treatmens)
However most studies only last 3-4 motns (Koran et al) many patients relax within a few weeks in medication is stopped
Therefore while drug treatments are effective short term, they may not provide a lasting cure (lacking data to provide evidence for longterm treatments)
Drug therapies preferred
advatages of drug therapies: involve little input from user in terms of effort and time
require little monitoring by doctors
in contrast thereapies (CBT) require patient to attend regualar metting and put considerable thought into tackling problems as well as therapist time
These benefits mean that drug therapies are more economical for health service that psychological therapies
All have side effects...
(See side effects)
These effects can be enough to make patients stop taking the drugs
therefore limits usefulness of drugs as treatments for OCD
effectiveness may be exaggerated by publication bias
Turner et al claim a publication bias towards studies that show a positive outcome of antidepressant drugs in the treatment of OCD
Consequently research may exaggerate the beneficial effect of these drugs or change the wording of a negative study to convey a positive outcome
drug companies also have strong interst in the success as they're capitalists and want money and much of the resrachis funded by these companies
Therefore selective publication can lead to innapropriate treatment decisions made by doctors that may not be in the best interests of their patients
Biological approach
Genetic explanation
COMT
gene regulates dopamine production
A less activate form of this gene is more common in OCD patients and produces higher dopamine levels
SERT
gene may also contribute by reducing serotonin
a mutation has been found in two unrelated families where 6/7 had OCD
Diathesis-stress
each gene only creates a vulnerability (a diathesis) for OCD
other factors = childhood experience, (trigger/stress) for condition to develop
Neural explanation
high dopamine + low serotonin
Orbiofrontal cortex of the frontal lobes and caudate nucleus; part of the basil ganglia; are abnormal in OCD people
Damage to caudate nucleus fails to suppress minor worry signals from OFC so creates a 'worry circuit'
Serotonin plays key role in operation o structures above, low serotonin levels may cause them to malfunction
Basil ganglia main neurotransmitter is dopamine so high levels = overactivity in that region
Ao3
Condcordance rate is never 100% so environment must have a role
menzies eta l 2007; used MRI to produce images of brain activity in OCD people and immediate family
OCD and cloe realtives had reduced grey matter in key regions like OFC
supports view that inherited differences may lead to OCD
brain scans used in the future to detect vunerability?
Other disorders have genetic links
OCD may have genes linked to tourettes and autism so could be a characteristic of many other disorders
Pauls and Leckman 1986; studied tourettes and concluded that OCD is one form of the same gene
Obessions and compulsions are also found in autistic children and people with anorexia nervosa
Supports view that there are no specific OCD genes but act as a factor towards obsessive behavior
Evidence for genetic from twin and family studies
Nestadt et al 2000; found people with 1st degree relative with OCD was 5x more likely to have it
Billet et al 1998; meta analysis found MZ twins over 2x more likley to have OCD if their twin did than DZ twins
Evidence supports genetic basis but OCD but concordance rate...
Alternative psychological explaations
two process model can be applied to OCD
-neutral stimulus (dirt) associated with anxiety
-compulsive behaviours (handwashing) maintain association by negative reinforcement
Exposure and response prevention (ERP) is a treatment similar to systematic desensitisation
-patients experience fear stimulus
-prevented from performing compulsions
Albucher et al 1998; most adults with OCD improved considerably with ERPsuggesting OCD has psychological causes as well as/ instead of biological causes
Anxiety disorder; persistent intrusive thoughts or impulses (obsessions) and repetitive behavior (compulsions)
Cognitive- thoughts or impulses. excessive and unreasonable
Emotional- belive they have no control so are embarrssed and ashamed about Os/Cs
Behavioral- compulsions (repetitive behaviors). e.g handwashing due to germ obsession.
Depression
Treatments
CBT
Ellis's rational emotive behavioural therapy (REBT), a type of CBT, aims to turn irrational thoughts into rational thoughts and resolve emotional and behavioural problems.
Ellis's model was expanded to ABCDEF.
D : disputing irrational thoughts and beliefs
E : effects of disputing and effective attitude to life
F : the new feelings that are produced
C: Consequence
B: Irrational belief
A: activating event
REBT focuses on challenging or disputing irrational, self-defeating thoughts and replacing them with effecive, rational beliefs. Logical, empirical and pragmatic disputing (Make sense? Evidence? Will it help?) can be used.
Ao3
Research support
Ellis claimed 90% success rate. And a review by Cuijpers et al 2013 of 75 studies found that CBT was superior to nothing
-However, Ellis recognised that the therapy wasn't always effective as some clients didn't put their revised beliefs into action
-therapist competence also has something to do with the success
This suggests that REBT is effective but it depends on the client and therapist
Support for behavioral activation
Babyak randomly assigned people with depression to a course of aerobic exercise, antidepressant drug treatmenst or both
-All 3 groups exhibited significant improvement after 4 months
-exercise group had a significantly lower relapse rate
This shows that a change in physical activity can indeed be benificial in treating depression
Alternative treatments available
The most popular treatment for depression is the use of antidepressants like SSRIs. Drug therapies also require less effort by the client than CBT
drug treatments could enable a depressed client to cope better with the demand of CBT
Cujjpers review says both is good
Therfore both is best
All methods of treatment for mental disorders may be equally effective
Luborsjy et al 2002; reviewed over 100 studies comparing different therapies. found on y small differences in effectiveness
Sloane et al 1975 showed that psychological therapies share many common factors e.g talking to someone and expressing thoughts
lack of difference between therapies might be result of the similarities they share. known as dodo bird effect (basically everyone gets a participation medal)
Cognitive approach
Beck 1967
Beck's (1967) negative triad model descrbed how childhood experience, such as continual parental criticism or rejection by others, lea to negative cognitive schemas developing.. These are activated in situations similar to those present when those schemes were learned
These systematic negative shcemas, and in cognitive biases such as generalisation, lead to depression
Negative scehmas maintain the negative triad of beleifs
-The self (e.g I'm unatrractive and boring)
-The world (e.g No one wants my company)
-The future (e.g I'll always be on my own)
Ao3
Blames the client rather than situational factors
The cognitive approach suggests that it is the client who is responsible for their disorder. This could give them the power to change the way things are
However, this may lead the client/therapist to look over situational factor that may have contributed to the disorder.
The strength of the approach therefore lies in its focus on the client's mind and recovery, but other aspects of the client's life may also need to be considered
Practical application for therapy
Effectiveness of CBT supports the usefulness of this approach
CBT is consistently found to be the best treatment for depression, especially when used in conjunction with drug treatments
If depression is alleviated by challenging irrational thinking, then this suggests irrational supports had a role in the depression in the first place
Support for the role of irrational thinking
Hammen and Krantz 1976 found that depressed Ps made more logic errors when asked to inspect written material than non-depressed Ps. proves depression is linked to irrational thoughts
Bates et al (1999) found that depressed Ps who were given negative automatic-thought statements became more and more depressed
Supports the veiw that negative thinking leads to depression. However, negative thinking may also just be a consequence.
Alternative explanations
depression can also be explained biologically, in terms of genetic factors and neurotransmitters
studies have found low levels of serotonin in depressed people. A gene related to low levels of serotonin is 10x more common in depressed people. Research shows drug therapies that raise serotonin are successful in treatment of depression
This means that neurotransmitters also play a role in causing depression and so a diathesis-stress model could be a better approach to take
Ellis ABC
proposed that when an activating event (A) leads to an irrational belief (B) and the consequences (C) may be depression.
Mustabatory thinking is the source of irrational beliefs like "I must be approved of by important people" or "I must do well or I am worthless". People who hold these beliefs may become depressed.
-For example, being fired at (A) might lead to the irrational belief (B) that the company had it in for you which could lead to the consequence (C) of depression
mood disorder
Behavioral; difficulties concentrating, decreased or increased activity, excessive sleep or insomnia, increased or decreased appetite
Emotional; sadness and/or loss of interest and pleasure in activities a person is normally interested in, feelings of despair, low-self esteem, lack of control and in-ward/out-ward directed anger
Cognitive; irrational negative thoughts about the self, the world and the future
Phobias
Treatments
Flooding
involves a single exposure but like a really intense one
exposed to actual phobic situation or to VR version until anxiety is gone
although fear is intense the response if naturally distinguished and fear is decreased
things is no longer associated with fear
Ao3
Effectiveness of flooding
can be effective treatment for those who stick with it
flooding and SD are equally effective but flooding can be highly traumatic and patient may quit
shows flooding can be useful for particular individuals so long as they’re aware beforehand of the distress that’ll happen
Strength of therapies
behavioural therapies are generally faster, cheaper and require less effort on the patient part
e.g CBT require willingness for patients to think deeply about their problem, not the case for behavioral
means SD at home can be just as effective; so cheaper and more accessible
means behavioral therapies can be useful for children and people with learning difficulties or disabilities
Relaxation may not be necessary
may be the success of both SD and F is to do with exposure than relaxtion
Klein et al 1983 compared SD with supportive therapy, found no difference in effectiveness suggesting the reason they work is just because of the hope of overcoming fear
suggests cognitive factors are more important than aknowledged
Effectiveness of SD
Research found that SD is good for a range of phobias
McGroth et al (1990) reported that about 75% respond to SD
in vivo is better than in vitro
different techniques involving modelling where patients watch someone coping well with feared stimulus
demonstrates effectiveness of SD and value of using many techniques
Systematic desensitisation
uses countercoding to replace fear with relaxation; relaxation inhibits fear- reciprocal inhibition
what they do
Patients learn a relaxation technique e.g slow breathing
They work out a desensitization hierarchy of phobic situations from least to most feared
hold stuffed bird
bird in cage nearby
stuffed bird nearby
bird out of cage nearby
hold feather
touch de burb
place a feather nearby
show real bird picture
show cartoon birb
In vivo- real life
in vitro- using pictures etc
work through DH until no anxiety with most feared stimulus
Behavioral approach
Two process model
Mowrer 1947
acquired by Classical conditioning
Neutral Stimulus, Unconditioned Stimulus, Unconditioned Response, Conditioned Stimulus, Conditioned response
Little Albert- Watson and Rayner 1920
paired NS of white rat with US of loud noise
Produced UCR from the loud noise which was then associated with white fluffy things
Maintained by Operant Conditioning
Fear is lowered by avoiding stimulus so avoidance becomes the negative reinforce
e.g afraid of spiders because they had been scared before, avoiding spiders would lead to fear reduction and lead to future avoidance
Ao3
Biological preparedness
Phobia not always developed after traumatic incident; Di Nardo- not everyone bitten by dogs has a phobia of them
Diathesis-stress model proposes a genetic vunerability that is triggered
Seligman argues that we are genetically ready to fear dangerous things like spiders that could've killed us in the past
Support for SLT
Bandura and rosenthal 1966, model acted as if there was pain when a buzzer osunded. Ps who observed demonstrated a fear of the buzzer.
shows that imitating behavior can also lead to phobias. e.g mum is scared of spiders so kid sees the attention given and wants in
Importance of CC
Sue et al 1994 found some people can recall a specific event that led to the phobia. e.g wax figures everywhere on SS GB and getting jumpscared
This shows that CC is involved
2P model ignores cognitive factors
cognitive aspects that can't be explained purely behavioristly
e.g person who thinks they may die while trapped in a lift may get really anxious and get a phobia of lifts from this
Shows irrational thinking is aslo involved
would explain why cognitive therapies work better
Anxiety disorder; irrational fear of a specific object or situation
main emotional characteristic; excessive and unreasonable fear. accomapied by anxiety and panic which the indiv knows is disproportionate
main behavioral characteristic; avoiding the stimuli. interferes with social or occupational functioning. flight fight freeze
Main cognitive; irrational thinking of the stimulus and resistance to rational arguement
Definitions of Abnormality
Deviation from Social Norms (DFSN)
Ao3
Distinguishes between desirable and not
effect behavior has on others
Abnormal damages others
Gives a practical way to identify undesirable and potentially damaging behavior
eccentric, abnormal or criminal?
Abnormal hurts, eccentric is just weird
definition doesn't differ between
implicit and explicit rules; deviation could break explicit rules (e.g murder) or implicit (e.g shouting too much)
Context
abnormal may not be a mental disorder in certain contexts
e.g swimsuit on the beach is fine but not in class
e.g shouting is weird but only a disorder if it's eccessive
Change over time
Gayness again; no longer a mental disorder
no permanent definition
Social norms- standard behavior set by social groups and followed by those in the group
Anyone different is abnormal
Some rules explicit or implicit
e.g gayness was illegal and called mental disorder, based on heteronormative society, 'deviated from social norms of what is acceptable'
Failure to Function Adequately (FTFA)
Not coping with everyday living
could cause distress for themselves or others; e.g hallucinations seem normal to them but are scary for others to witness
DSM WHODAS, 6 areas
Understanding and communicating
Getting around
Self care
Getting along with people
can perform general life activities
Participating in society
Ao3
Recognises individual's subjective experiences
Can views from the indivs POV
can use WHODAS criteria to measure ability to function, so can measure it objectively
therefore has sensitivity and practicality
Behavior may be functional but still abnormal
disorders may lead to extra attention to the indiv, and the attention is rewarding so is more functional
definition is incomplete; fails to distinguish between dysfunctional and functional
Some dysfunctional behavior can be beneficial
Statistical infrequency (SI)
Mean, median, mode, range, standard deviation
Ao3
One of a number of tools
can establish a cut off point
IQ example; when IQ is more tha 2 standard deviations below it's a mental disorder but 2 above and it's amazing
Can be used alongside with FTFA
Some traits are desirable
High IQ is actually a god thing
Some common traits are bad; e.g depression
Can't distinguish between good and bad
Cultural/ historical relativism
Abnormal here may be normal there; e.g hearing voices is schizo in western places but could be normal elsewhere
No universal definition of abnormality
Cut off points are subjective
Have to decide where to separate normal and not
E.g depression includes difficulty sleeping but no sleep depends of the person idea of no sleep
Disagreements make it hard to define
What is the most common?
Normal distribution, e.g fear of dogs rated from 1-10, most would say 4-7, extremes are abnormal
Deviation from ideal Mental health (DFIMH)
Jahoda 1958 has 6 criteria needed for idea mental health
self actualisation
integration (coping with stressful situations
autonomy
accurate perception of reality
positive self attitude
mastery of the environment
Absence of any criteria needed fro ideal mental health means you have a disorder
Ao3
unrealistic
apparently most people are abnormal
self actualisaton only happens to .1%
very difficult to measure some criteria; e.g capacity for personal growth like what
also how many need to be lacking for one to be abnormal??
means the approach may be good in theory but unusable in practice
Positive
offers an alternative perspective on mental disorders as most just focus on the negatives
even though Johoda's theories are wack and never used, the idea have some influence and are in accord with the positive psychology movement
a strength is in it's positivity and influence on humanistic approaches
Cultural relatism
different ideas of life in different cultures
adequate functioning depends on cultural norms
Jahoda's criteria may not apply to collectivist societies
could explain why there are more people in ethnic minorities or lower classes diagnosed with disorders
Explaining abnormality
Behavioral
all behavior is learnt
learning can be controlled by conditioning and modelling
what was learnt can be unlearnt
applies to humans and animals
cognitive
fault of abnormal cognition
fix thoughts to fix disorder; think rationally and positively
biological
all disorders have a physical cause
illness can be described by symptoms; symptoms can be identified
diagnosis leads to appropriate physical treatments
