Psychopathology

Definitions of abnormality: 

Need to be objective and not under or over-inclusive. 

Statistical Infrequency:

●      Abnormal behaviour if it is rare or statistically unusual

●      It is objective because there are clear numerical guidelines to class behaviours as abnormal – healthcare workers can view same behaviours in same way

●      However, it doesn’t account for desirability (high IQ is desirable but abnormal whereas depression is abnormal but undesirable)

Failure to function adequately:

●      Unable to cope with demands of everyday life, causing distress to themself or others 

●      Rosenhan & Seligman (1989) characteristics:

○      suffering

○      maladaptiveness (danger to self)

○      vividness & unconventionality (stands out)

○      unpredictably & loss of control

○      irrationality/incomprehensibility

○      causes observer discomfort

○      violates moral/social standards

●      Negative: Abnormality looks different in different cultures 

●      Negative: Rosenhan & Seligman criteria is subjective because it’s not a scale or measuring tool – based on opinion & observer’s understanding 

Deviation from social norms:

●      Violates unwritten rules about what is an expected or acceptable behaviour in a social group, making people feel threatened/uncomfortable 

●      Negative: Social norms change over time e.g. homosexuality

●      Negative: Context and extent need to be considered (abnormality or harmless eccentricity) 

Deviation from ideal mental health:

●      Mary Jahoda defines what’s normal and anyone who differs is abnormal 

●      Good mental health characteristics:

○      positive self-attitudes

○      personal growth

○      autonomy and independence

○      accurate perception of reality

○      environmental mastery (able to meet the varying demands of day-to-day situations, including interpersonal relationships)

○      integration

●      Positive: It is a positive approach – not taken up by health professionals but did influence humanistic psychology

●      Negative: Ideas rooted in Western concepts – value in personal growth, autonomy and self-actualisation which aren’t so recognised in collectivist cultures

Behavioural approach to explaining and treating phobias:

The two-process model (Mowrer):

1. Classical conditioning is the first stage
   1. Responsible for the acquisition of the phobia 
   2. NS is associated with the US, producing the UCR of fear. NS takes on qualities of the US, becoming the CS. 
   3. UCS: being bitten by a dog,  unconditioned response (UCR) of fear. Dog = neutral stimulus is present when the bite occurs, it becomes associated with the UCS and takes on some of the qualities of the UCS. Dog becomes a conditioned stimulus which can produce the conditioned response of fear. 
2. Operant conditioning is the second stage
   1. Responsible for the maintenance of a phobia 
   2. People are motivated to avoid the stimulus they fear, and doing this reduces the anxiety caused by thinking of the encounter. 
   3. Anxiety reduction = rewarding = negative reinforcer so avoiding the stimulus is more likely

Analysis & evaluation:

●      Positive: Along with Watson & Raynor’s study, there’s other supportive evidence that strengthens the model. Di Gallo – 20% of individuals in traumatic car accidents develop fears of travelling in cars (acquisition of the phobia). They then avoid cars fitting with the theory that people maintain the phobia through -ve reinforcement. Additionally, Di Nardo found that 60% of dog phobia sufferers could relate their fear to a particular experience.

●      Negative: There’s still a large proportion of people who can’t relate their acquisition to an event (40% Di Nardo dog phobia). Bandura & Rosenthal suggested this is because people learn phobias by vicarious classical conditioning, which is particularly commonly reported for arachnophobia. Therefore it doesn’t account for all phobias.

●      Positive: There have been treatments built around the predictions of the two-process model

○      McGrath et al found that 75% of patients respond positively to systematic desensitisation & Choy et al reported that flooding is even more effective

○      Both are based on counterconditioning and if phobias weren’t caused by CC/OC then it would be impossible to overcome them using methods to reverse conditioning

Systematic desensitisation (Wolpe):

●      Several short sessions using counterconditioning 

●      Pair (associates) conditioned stimulus with new stimulus (relaxation) which produces the new conditioned response of being calm

●      Reciprocal inhibition – anxiety and relaxation are incompatible

●      Method:

○      Relaxation techniques (e.g. breathing/grounding)

○      The therapist and patient together work to create an anxiety/desensitisation hierarchy – list things about interacting with the stimulus that scares them from least to most frightening (covert/thinking or in vivo/real life)

○ The patient works at the lowest level of the hierarchy, causes anxiety and the therapist encourages the use of relaxation techniques. Repeat a couple of times until the associated phobic stimulus is with relaxation so c.response is calm (counterconditioning)

○      At each stage, relaxation techniques are used to counter condition 

○      Once right at the top of the hierarchy, mastery of phobia

●      Supportive evidence Gilroy: the control group had no exposure to the hierarchy (no chance of counterconditioning) but were taught relaxation techniques, and at 3 months and 33 months the exp group were less fearful of spiders. McGrath et al also found 75% success rate

●      Negative: Patients need to be highly motivated because it involves direct engagement with the phobic stimulus which can increase anxiety and Choy et al said in vivo techniques are needed for SD to be effective. There is a high dropout rate (only 75% effective for those who actually complete the course)

●      Negative: Not good for all phobias. Wolpe himself gave an anecdote of treating patients with anachrophobia with SD which wasn’t working, had marital problems and her husband referred to her as insects like spiders – she had worried about her marriage which was displaced onto the spiders. Wolpe came up with SD so it weakens it.

○      Little Hans resolved phobia by resolving Oedipus complex

○      SSRIs – can improve anxiety in up to  80% of people with social phobia which would suggest more effective than SD (75%)

Flooding (Stampfl): 

●      One intense long session

●      Another form of counterconditioning based on reciprocal inhibition 

●      Method:

a.     Taught relaxation methods like box breathing, or 54321 (grounding)

b.     Expose you to the most frightening stimulus 

c.     Fight or flight response occurs (acute stress reaction) – aren’t able to leave, a high spike of adrenaline only lasts about 20 minutes until the body goes into chronic stress reaction and stops producing adrenaline 

d.     Person calms down because they can’t maintain the fear response so they start to use their relaxation techniques until completely calm and have counter-conditioned their previous stimulus-response link

●      Positive: It is cost-effective: Ougrin said it’s equally as effective as other therapies but quicker and more accessible. Choy et al said flooding is more effective than SD

●      Negative: Highly traumatic – there are frequent dropouts which are wasted money that isn’t cost-effective after all. If it’s not completed, the association strengthens the association making the phobia worse

●      Negative: Overall Wolpe’s anecdote shows that counterconditioning isn’t the only way to treat phobias. Little Hans, SSRIs. 

Biological Explanation of OCD:

Neural explanation:

●      The difficulty in decision-making is due to sufferers having abnormalities in their frontal lobes (area in control of logical thinking and decision-making)

●      The orbitofrontal cortex (OFC) and caudate nucleus are part of the circuit translating sensory info into thoughts and actions. Also suppresses worry signals that could trigger action unnecessarily 

●      With OCD, worry signals fail to be suppressed so more signals are sent to the thalamus, which passes back worry signals to the OFC creating a worry circuit

○      Explains the high levels of obsessions and the need to act on compulsions because anxiety keeps escalating 

●      Failure to suppress the signals likely due to a neurotransmitter imbalance, caused by variations of the COMT/SERT gene (high levels of dopamine and low levels of serotonin)

Genetic explanations:

●      Genes impact OCD because they affect the presentation of neurotransmitters

●      Innate predisposition (polygenic) towards OCD inherited from parents via genes 

●      COMT gene:

○      Involved in the production of the protein that helps regulate the production of dopamine

○      Variation common to OCD sufferers is lower activity than the normal gene so it is less effective at regulating dopamine so people have higher levels of dopamine (excitatory neurotransmitter)

○      Overall there are more neurons firing 

●      SERT gene:

○      Involved in the production of the protein that helps transport serotonin from the synaptic gap back into the presynaptic neuron

○      People with this variation of the gene have lower levels of serotonin, which acts as an inhibitory NT to suppress sorry signals in the OFC and caudate nucleus 

○      Lower levels contribute to the failure to suppress worry signals so obsessions run through people’s minds, and the loss of a mechanism to prevent task repetition resulting in compulsions 

Analysis:

●      Positive: Real-life application of drug therapies’ effectiveness suggests the biological explanation is correct. Julien: drug therapy reduced symptoms in 50-58% of patients, allowing them to live a ‘normal lifestyle’. Drugs mostly limit reuptake of serotonin so it’s fair to assume the improvement is due to the improved inhibitory action of serotonin in the OFC and Caudate nucleus, which lessened the worry circuit activation. Soomro et al  meta-analysis of 17 studies found that SSRIs were more effective than placebo so the improvement is due to biology not the placebo effect

●      Negative: Biological factors may not be causing OCD which would undermine the explanation. Simpson et al –  high relapse rate of 45% within 12 weeks of completing the medication, a higher rate than the 12% after a non-biological therapy. Suggests the drugs treat the symptoms, not the cause, making the biological explanation wrong. OCD may be caused by a combination of environmental and biological predispositions, triggered by the environment.

●      Negative: Further evidence to suggest an interactionist approach would be a better explanation. The two-process model could be a viable alternative; Albucher et al – between 60%-90% of adults reported considerable improvement in symptoms when treated with exposure and response prevention (ERP) – a therapy based upon the idea of extinguishing previously learned stimulus-response links. If only biological factors cause OCD, the therapy would have no impact on the patient and as it does, it weakens the biological explanation.

Drug therapy:

●      SSRIs (selective serotonin reuptake inhibitors) e.g. fluoxetine

●      Raises the amount of serotonin by stopping so much from being taken back up into the presynaptic neuron, it can then act as an inhibitory neurotransmitter and reduce the chance of an AP which causes anxiety

●      Consequently calms activity in the OFC and quietens the worry circuit, preventing obsessions and compulsions from occurring 

●      There are other drugs used as a second resort if SSRIs aren’t working: Tricyclics, e.g. clomipramine, which prevent the reuptake of serotonin and noradrenaline 

○      More side effects because two NT affected

Analysis:

Positives:

●      Effective at reducing symptoms which is important to those who take the therapy:

○      Julien – reduction in symptoms for 50-58% of patients, allowing a normal lifestyle

○      Soomro et al – SSRIs more effective than placebos so changes in symptoms due to the drug affecting physiology/NT rather than the placebo effect

Negatives:

●      There are negative aspects of the treatment:

○      Simpson – up to 45% of people relapse within 12 weeks, compared to 12% for psychological therapy

○      Also side effects – SSRIs cause nausea, headaches & insomnia and Tricyclics cause hallucinations/irregular heartbeat 

●      There are other treatments which may be more effective:

○      Albucher et al: CBT based on ERP (exposure and response prevention) 60-90% of people report considerable improvement in symptoms (obsessions/compulsions)

○      Recommended by OCD UK and widely available on NHS (suggests it’s good)

Overall, drug therapy shouldn’t always be the first resort as it may not be the most effective therapy and can cause side effects just because it is cheaper.