Psychopathology, Theories and Treatment Revision notes (Psychology AS)

Biological approach – ways to study genetics

Weissman et al – family

• Relatives of people diagnosed before the age of 20 and 8 times greater chance of being diagnosed with depression if their relatives had depression
• Not clear if findings were due to genetics or shared environment
• Results from family studies can be inconclusive

Muguffin et al – twins

• Studies twins where one already suffered from depression
• MZ twins – 46% concordance (suffer from the same conditions) rate for depression
• DZ  twins – 20% concordance rate for depression
• Can’t tell if findings are due to genetics or shared environment

Wender et al – adoption

• Biological relatives have a 8 times more likely chance to have depression than adopted relatives

Treatments

ECT – electro convulsive therapy

• Anesthetized – after consent
• Muscle relaxant tongue and teeth guard – protect
• Shocked with around 100volts for 3-4 seconds
• Patient experiences slight seizures that last from 30 seconds  - 1min
• 3-6 treatments per week for several weeks
• Effectiveness is 70%
• Numbing – no emotion
• Long term can be damaging
• Memory loss
• Can they give informed consent if they are sectioned?

Drugs

• Fast acting
• Cheap

Benzodiazepines 

• Reduce tension and anxiety
• Drowsiness
• Fatigue
• Weight gain
• Can have interactions with other medication

Anti-depressive drugs

• Increase serotonin, SSRI interferes with re-absorption of serotonin creating high levels
• Dizziness
• Dry mouth
• Nausea

Anti-psychotic drugs: neuroleptics

• Major tranquilizers
• Decrease production of dopamine
• Relieves hallucinations, hostility
• Weight gain
• Dizziness
• Drowsiness
• Dry mouth

Exam content for treatments for the biological approach  

• Two ways in which you can treat abnormality according to the biological approach – drugs and ECT
• The biological approach suggests that different drugs can treat abnormality
• Benzodiazepines - work by slowing down the activity of the central nervous system and reduce central arousal. BZs enhance the actions of GABA which is a neurotransmitter and is the body’s natural form of anxiety relief
• Benzos reduce the tension and anxiety
• Anti-depressive – raise levels of serotonin and noradrenaline
• When helps treat depression
• Anti-psychotic drugs act by reducing dopamine activity in the brain
• Which relieves symptoms in schizophrenia such as hallucinations and hostility
• Drugs can be effective for many different disorders – but some disorders such as phobias, panic and eating disorders cannot be treated with the drugs
• Only treat the symptoms of the disorders via their effect on the biological changes in the brain and therefore is a highly reductionist treatment that ignores cognitive, emotional and environmental influences.
• Many side effects
• ECT
• After giving consent they are anesthetized
• Given a muscle relaxant, tongue and teeth guard to protect them
• Given a minor shock of 100volts for 3-4 seconds
• Patient may experience a slight seizure that may last 30secs to a minute
• 3-6 treatments per week for several weeks  
• Effective – 70% improvement on depression
• Can they give informed consent if they are sectioned ( are they emotionally capable)
• Long term treatment has been proven to damage memory and cause memory loss
• Can be numbing for the patient and although their depression may be better they will have no emotion

Cognitive approach

Human behaviour is heavily influenced by schemata

NATS – negative automatic thoughts

• Negative schemata can develop based on early experiences. When they are activated they can lead to negative automatic thoughts.
• Unconscious and rapid response to situations
• Cognitive biases that depressed people apply when they interpret situations
• Becks cognitive triad 

Ellis’s ABC Model

Exam

• Becks cognitive triad is the first model – describes how peoples disorders can be caused by negative views about themselves, about the world and about the future
• These beliefs can feed into each other which continues disorders such as depression
• Ellis’s ABC model also explains abnormality through beliefs and behavioural consequences
• This model suggests that an activating event causes beliefs
• These are either rational or irrational
• These can lead to consequences; desirable or undesirable emotions and desirable or undesirable behaviour
• It is the irrational beliefs and consequences that maintain disorders such as depression
• Cognitive biases can be internal, global or stable
• Depressed people use cognitive biases to view the world
• Clear evidence for cognitive biases – Clarke found that individuals with panic disorders exaggerate the significance of physical symptoms
• Therapy based treatments are effective in treating anxiety disorders and depression e.g. CBT and REBT
• Idea of schemata and NATS are vague and unexplained – it’s not clear how irrational thoughts are designed and measured
• Approached is reductionistic as it reduces psychopathology down to a simple set of factors  - reduces the validity of the approach
• Not clear if the negative thoughts lead to disorders such as depression or depression leads to negative thoughts – cause and effect cannot be inferred reducing the validity of the approach

Treatments for cognitive approach

 CBT – cognitive behavioural therapy 

Beck CBT

Stage 1 – therapist and client agree on nature of problems and goals for the therapy

Stage 2 – therapist challenges the client’s negative thoughts and aims for client to realise irrational thoughts and encourage positive thoughts

Stage 3 – client engages in behaviour between sessions in an attempt to challenge these negative thoughts

Evaluation of CBT

• Shown to be as effective as drug treatment therapy for treating depression and anxiety, improvements may last longer
• CBT assumes that the cause of depression for example, lies in maladaptive thoughts so it is targeting the cause of abnormality not just the symptoms
• Effective for depression and anxiety, it is less effective for phobias than systematic desensitisation and severe disorders such as schizophrenia are not suited for CBT
• Cognitive approach ignores genetics and biological factors in abnormality
• CBT avoids in depth probing associated with psychoanalysis – some may find the diary keeping and self-monitoring associated with CBT stressful
• Emphasis on CBT is on cognitive change or restructuring and behavioural change, without cognitive change is unlikely to help a depressed person

Ellis REBT - rational emotive behavioural therapy 

An event activates irrational thoughts which lead to negative emotions

Ellis believes people maintain negative emotion by always telling themselves how inadequate they are

Stage 1 – therapist and client identify negative situation

Stage 2 – therapist helps rationalise the situation and show them a realistic perspective

• More confrontational approach than beck – Be more effective

Behavioural approach

• Emphasis of behaviour on environment and how behaviour is enquired and primarily concerned with observable behaviour
• Classical conditioning  is learning through association and best explains the development of phobias
• Unconditioned stimulus leads to a conditioned response, with a conditioned stimulus leading to a conditioned response
• For example, a fear of spiders and associated with another stimulus which creates the phobia
• Operant conditioning – learning with rewards and punishments
• This could be the theory that leads to anorexia
• If someone losses weight and they are complimented – it’s a reward and they are more likely to repeat it = eating disorders
• Social learning theory – learning through observation and imitation
• Look at a role models behaviour, if they are being rewarded the individual my go down the same route as the role model is seen as successful (vicarious reinforcement)
• This theory can also be linked to eating disorders – exposure of young girls to successful thin women In the media
• This linked is to pschopathogies because that maladaptive behaviour can also be learnt
• Strong research support for the role of learning for example, Watson’s study on little albert demonstrated how phobias can be created through the process of classical conditioning  - provided strong support
• Little evidence that severe psychopathology can be caused the same way (schizophrenia) – reduces the validity of the approach
• Support comes from treatments such as systematic desensitisation can be effective for treating disorders such as phobias but not for complex disorders like schizophrenia
• Reductionistic – reduces complex psychopathological problems to simple learning and ignores the influence of biological and cognitive approaches.

Therapy

 Systematic desensitisation

• Form of counter-conditioning  where the therapist attempts to replace the fear response by an alternative and harmless response
• Involves using a hierarchy of increasingly fearful situations :
• For spider phobias the therapist would ask the personal to list situations from least to most fearful
• Therapist trains the client in deep relaxation techniques – is the alternative and harmless response – aim to replace fear with relaxation
• The therapist trains the client to visualise the least feared situation  - perform relaxation technique
• Once they feel comfortable they are asked to imagine the next situation on the hierarchy – same thing happens
• Over sessions the client will cope with every level of the hierarchy, although they can stop at any time and restart at a lower level  

Flooding

• Remove the learned association between stimulus and the response
• Involves inescapable exposure to the feared object or situation that lasts until the fear response disappears
• For example someone who is has claustrophobia might be shut in a small room  until their initial high levels of anxiety reduces  

Aversion Therapy

• Aims to associate undeniable behaviour with an unpleasant stimulus
• Can be used as therapy for addictive states
• Pair an unpleasant or punishing stimulus with, for instance smoking or drinking
• One way to do this is to make the person feel sick using pills whilst they are smoking
• Through classical conditioning the feeling of sickness is associated with smoking and should act to prevent smoking in the future

Evaluation on therapies

• Assumption of the behavioural approach, that all behaviour is learned through simple conditioning principles, mean that therapy targets these associations
• Systematic desensitisation can be very effective in phobias – success rate 60 and 90% have been reported for spider phobias and blood infection phobias
• Ethical issues – intense fear and anxiety – careful when monitoring them to ensure there are no long term negative consequences for the client

The Psychodynamic approach

• Abnormality is caused by unresolved, unconscious conflicts in the mind formed in childhood which will later effect adult behaviour
• all behavior has a cause (usually unconscious; therefore all behavior is
• The Id is the pleasure seeking part of the personality
• the super ego insists of the morally right choices
• the ego mediates the opposing demands of the id and super ego
• lack of balance between the id, ego and super ego can lead to abnormality
• when faced with conflicts or trauma the ego protects itself with defence mechanisms
• include denial and regression which has been linked with schizophrenia and repression which is linked with depression
• First to emphasise the importance of unconscious processes in child and adult behaviour – accepted that repression of painful childhood experiences can lead to adult disorders such as depression and anxiety
• Effective treatment- psychoanalysis can be effective, so if the treatment is effective then the approach the treatment is based on must be correct and valid
• Weak evidence to support the idea that anxiety causes mental illness- evidence is based on repressed Viennese Victorian women. So the theory may, only apply to women and only women from Vienna and can be out of date
• Reductionist- ignores other factors such as genes and the environment, so the explanation can only give a limited understanding of the mental illness in question
• Freud didn’t study children directly – worked with adults with abnormality then associated their problems with earlier experiences
• Concepts such as id, ego and superego are impossible to test using scientific methods – they cannot be validated  

Therapies

Free association

• client is encouraged to express anything on their mind
• each incident may lead then, though free association of ideas, lead to other thoughts and memories that could extend to childhood
• client must not censor the material and in this freewheeling way ego defences may be lowered and repressed material is accessed  
• therapist may intervene to encourage reflection on a particular experience
• also will identify key themes and ideas that can be analysed further in the process
• Freud introduced this to get around the defences put up by the ego n so bring the surface material from the unconscious

Dream analysis

• Freud referred to dreams as the royal road to the unconscious
• During dreams the normal barriers to unconscious material were lifted and the symbolic imagery of dreams was a reflection of this unconscious material
• By analysis the content the therapist might be able to see conflicts repressed into the unconscious
• The therapist’s role is to use their understanding of how the dream work operates and interpret the meaning
• They can then work through the issues, identifying and resolving the source of anxiety

Freudian slips

• Words accidently said out load which can indicate what a person is really thinking and can show any unconscious thoughts related to childhood experiences
• The psychoanalyst will interpret responses and feedback to clients. The patient’s responses are used as evidence to get transference (moving the conflict onto the therapist. Therapy may be cathartic and require the patient to visit 4 times a week sometimes for years.

Inkblot tests-

• random shapes with no meaning. The patient looks at them and tells the therapist what they see. This triggers the unconscious mind as the description of the shape helps to reveal what is in your unconscious thoughts

Evaluation

• very complex – psychoanalysis can be long, expensive and lasting months or years
• client has to be willing to undergo self-analysis and develop insights to their condition – schizophrenia doesn’t have an insight to their condition therefore wouldn’t be helpful
•   effective therapy for anxiety and depression
• Ethical problems – free association and dream analysis can lead to reveal traumatic events from childhood that can lead to distress and client may need long term support to come to terms with these events