What is normal? Before we can begin to explain and treat psychological abnormality, we must first define what we mean by ‘normal’ and ‘abnormal’ Abnormality is difficult to define. Views of abnormality change across cultures, vary within cultures

over time and vary from group to group (e.g. Chavs and Goths) even within the same society (cultural relativism).

It is essential to examine views of abnormality as they form the basis for defining and identifying psychological disorders.

How do we decide what is ‘normal’ or ‘abnormal’, and therefore whether the behaviour constitutes a psychological disorder (e.g. depression, schizophrenia, phobias, post-traumatic stress disorders, eating disorders etc.)

This definition asks one simple question:How unusual is the behaviour being displayed?

If it is statistically unusual, then it is classed as abnormal. For this reason, the explanation is sometimes known as 'statistical infrequency'.

A norm is a standard or rule that regulates behaviour in a social setting. Norms are socially acceptable or ‘normal’ standards of behaviour. Abnormality, then, is defined as moving away from the norm, non-compliance with society’s norms and values. In statistical terms human behaviour is abnormal if it falls outside the range that is typical for most people. In other words, the average is ‘normal’. Things such as height, weight and intelligence fall within fairly broad areas. People outside these areas might be considered abnormally tall or short, fat or thin, clever or unintelligent etc. In statistical terms they are abnormal because their behaviour has moved away from the norm.

Topic 1: Definitions of Abnormality

AO1

1) Abnormality as behaviour that deviates from the statistical norm also known as ’statistical infrequency’

Statistical Deviation Deviation from social norms Failure to function adequately Deviation from ideal mental health

Strengths & limitations associated with these definitions

1

Example: - The Normal Distribution Curve for IQ

IQ is calculated using psychometric intelligence tests. ( These tests give a mental age, which is divided by chronological age and multiplied by 100 to give an IQ score so the norm for IQ is 100 because if mental age and chronological age match IQ is 100 e.g. mental age 17/chronological age 17 X 100 = 100.) Anything between 70 and 130 is considered normal for IQ, an IQ of less than 70 or more than 130 is statistically infrequent and therefore considered abnormal.

Mark on the normal distribution graph above the norm or average IQ score and the cut off points for abnormality (e.g. 100, 70 and 130).

So, we can identify people who are a long way from the mean.However, an obvious problem here is that this doesn't take into account whether the behavior is desirable or not (e.g. is a high IQ 'abnormal'?)

Limitations: How is statistical infrequency limited as a definition of abnormality?

Some evaluation points:

The cut off points are rather arbitrary. How can someone with an IQ of 70 be considered normal, whilst a person with an IQ of 1 point difference (69) be considered abnormal?It ignores desirability of behaviour, in terms of IQ we might accept that someone has an abnormally low IQ, but we would probably all wish to have a high IQ and wouldn’t label that as abnormal.Some disorders, for example depression, are statistically very frequent, but still classified as abnormal.Cultural and historical relativism: - what is statistically frequent and acceptable in one culture and time period is not necessarily the norm in another. For example, arranged marriages are statistically frequent in India, Marijuana smoking is statistically frequent in Jamaica.

Look in your text books … could you add to this list?

OBB pg 187GHG pg 134

AO3

2) Deviation from Social Norms - Abnormality as behaviour that deviates from the social norm

2

Every society or culture has standards of acceptable behaviour/norms. Behaviour that deviates (moves away) from these norms is considered abnormal. Social norms are approved and expected ways of behaving in a particular society or social situation. For example, in all societies there are social norms governing dress for different ages, gender and occasions.

a) Identify 3 behaviours that are considered social norms in our society

b) Why might we consider behaving according to ‘social norms’ a good thing?

c) What is the difference between ‘eccentric’ behaviour and ‘deviating from social norms?’

d) Is deviating from social norms always a bad thing? Can you think of people in history who deviated from the social norm?

Limitations: - How is this definition limited in terms of defining psychological abnormality?

Social norms are implicit rules about how we ought to behave in society. Anything that violates these norms is considered abnormal

AO3

AO1

OBB pg 184GHG pg 134

3

In pairs, using your text books, make some notes below of the limitations to this definition: think of the following headings: Abnormal or eccentric? The role of context? Changes over time? Social control? The role of culture?

Failure to Function AdequatelyAn inability to carry out everyday tasks and lead what would be considered a ‘normal’ life.

Identify some psychological disorders that may stop an individual ‘functioning adequately. Explain why…..

A failure to function adequately means that a person is unable to lead a normal life or engage in normal behaviour. For example, they may be unable to hold down a job or take part in everyday activities, such as shopping or work. An agoraphobic would be considered abnormal because their fear of leaving the house would seriously impair their ability to live a normal life.

There are various indicators of failure to function adequately, the greater number of these indicators a person has the more likely they are to be diagnosed with a psychological disorder and therefore labelled ‘abnormal’.

Rosenhan & Seligman (1989) suggested certain features that may indicate whether someone is functioning adequately or not. It is important to remember that any one, or even small number of these, is by no means unusual. However, if a person is experiencing many or all of them, then this would constitute cause for concern.

Using OBB complete the descriptions for each factor:

3) Abnormality as failure to function adequately

AO1

OBB pg 186GHG pg 136

4

Evaluation: using your text books, in pairs, complete the following

Task: - What are the limitations of this definition of abnormality.

We need to look at the context in which the individual is “failing”….

Many people live very functional lives despite having a clinical diagnosis of a disorder…

Ethnocentric criteria – these criteria may not be applicable to other cultures…

Who judges that someone is failing to function….

So far we have outlined definitions of abnormality. This definition instead attempts to define normality, and assumes that absence of normality indicates abnormality.

AO3

4) Abnormality as deviation from ideal mental health

5

Criteria DescriptionObserver discomfort

Unpredictability

Irrationality

Maladaptiveness

Personal suffering and distress

However, normality is as difficult to define as abnormality. Marie Jahoda (1958) approached this problem by identifying various factors that were necessary for ‘optimal living’ (maximising enjoyment for life). The presence of these factors indicates psychological health and well-being, so an absence of any of these would help us define abnormality

Jahoda’s idea of ideal mental health. Use pg 188 in OBB to outline each one

Lovely animation of Jahoda which can be access from GHH: https://www.youtube.com/watch?v=e9vhaT_GR2A

Evaluation Task: - Consider each of the factors in turn. Are you normal? What are the limitations of Jahoda’s elements of optimal living?

Is it realistic to accept that we can achieve all these criteria?

Cultural Relativism –what does this mean in the context of mental health?

AO1

AO3

OBB pg 188GHG pg 136

6

Is mental health the same as physical health?

ISSUE IN PSYCHOLOGYThere are many issues and debates in Psychology. You have already come across many of them: nature vs Nurture, ethnocentric, animal research, reductionism, deterministic, ethical issues. Another issue that you need to be able to refer to is CULTURAL RELATIVISM – similar to ethnocentrism.

Cultural Relativism: - Every definition of abnormality is limited by cultural differences. What is or is not considered psychological abnormality is mediated by cultural norms and values – this is known as cultural relativism – what is normal and acceptable in one culture is not necessarily in another.

Culture refers to all ways of thinking, feeling and acting that people learn from other members of society. Different cultures will show cross-cultural differences in beliefs, traditions, norms etc. and may have different views on defining and classifying abnormality. For example, in the West Indies it is perfectly acceptable to admit to hearing voices, it is considered a religious experience, people pray and God answers them. In Britain, hearing voices is considered a symptom of schizophrenia.

Task: - Working in pairs, can you give examples of behaviour which would be regarded as abnormal in our culture, but not in another?

Subculture:

This refers to a social group within a society e.g. gender, social class, age and ethnic groups. The dominant culture within a society is likely to be seen as the norm and subcultures as abnormal. The frequency of mental disorders can vary in relation to subcultures. For example, schizophrenia is between twice and eight times more prevalent in lower socio-economic groups in society. Rack (1984) found that African Caribbean’s in Britain are sometimes diagnosed as mentally ill, on the basis of behaviour which is perfectly normal within their subculture (hearing voices and smoking marijuana (cannabis psychosis)). Women are also more likely than men to be diagnosed with clinical depression. Some mental disorders have been found to be specific to certain cultures. The term given to these disorders is Culture Bound Syndromes (CBS), for example PMT and Anorexia Nervosa are particularly Western disorders.

Definitions:- Read through these descriptions of people with problems. Ask yourself which of the definitions you could use in order to show that the person was psychologically abnormal. For each case, select two of the definitions and explain why you have chosen

those two definitions.

7

1) A young woman reports that she has an acute fear of snakes. She cannot bear to watch any films or television programmes which include snakes. If she sees a picture of a snake, she becomes very anxious or distressed. If she sees a toy snake in a toy shop, she wants to walk away. She certainly will not go anywhere near a zoo……………………

2) A young woman, who lives alone with her mother, believes that the world beyond her house is filled with radio waves which will insert evil thoughts into her head. For this reason, she never leaves the house. She covers her bedroom window with aluminium foil because she believes that this will protect her. She claims to hear voices which tell her that she should give up the fight against the evil waves.

3) A middle aged man with a wife and two young children becomes very anxious when shift patterns at the factory where he works are changed. He finds that he bursts into tears when he is in the bathroom first thing in the morning, he worries about his work constantly, he cannot talk to his wife or his friends about how he feels and he starts to take time off sick which he has hardly ever done before. At some points, he even contemplates suicide.

4) A middle aged woman has an extreme fear of germs and bacteria. She will only allow visitors into her house if she is convinced that they are clean. She goes through elaborate rituals when performing ordinary tasks. For example, when making a cup of tea, she will fill and empty the kettle fourteen times in order to make sure that the water is clean.

5) A young woman has abandoned a course at university after a year because of health problems associated with very low body weight. She is totally preoccupied with food. For several years, her dreams have often been about food, for example dreaming that she falls through a pool of spaghetti. She makes a ritual of the way she eats, she daydreams about food and she is constantly reading recipes for meals.

DEFINITIONS OF ABNORMALITY – Summary

Concept map: around each circle identify the key points of the definition and 3 limitations. Use A3 sheet for more space

Deviation from Statistical Norms 8

Phobias, Depression and OCD

The behavioural, emotional and cognitive characteristics of each disorder

Deviation from Social Norms

Failure to Function Adequately

Deviation from Ideal Mental

Health

9

Phobias:

Phobias are anxiety disorders. Whilst it is perfectly normal and in fact beneficial to be afraid of certain things, fear of something is not a Phobia. A fear only becomes a Phobia when it negatively impacts on a person’s everyday life e.g. not being able to enter your garden in case there is a frog there!

1. Discuss in pairs some common phobias:

BEHAVIOUR: How is each disorder

characterised? What behaviours are associated with each disorder?

EMOTIONAL: How does each

disorder affect the emotional feelings of the individual?

COGNITIVE: The way in which

each disorder affects the thought processes of the individual – how is their thinking affected?

OBB pg 190GHG pg 138

10

2. You need to be able to describe behavioral, emotional and cognitive characteristics of phobias: Behavioural characteristics are categorised by avoidance behaviours. There will be physical

symptoms, the fight or flight response will be evident when confronted by the phobic object or situation or even the thought of it.

Key behavioral characteristics/symptoms of phobias:

Emotional characteristics are an intense fear and emotional upset. The person will become visibly distressed at the sight or thought of their phobic object or situation.

Key emotional characteristics/symptoms of phobias:

Cognitive even though the sufferer realizes that their fear is irrational they are unable to control their obsessive thoughts which make the phobia worse.

Key cognitive characteristics/symptoms of phobias:

3. Reminder yourself briefly of the Watson and Rayner (1920) Little Albert study

APRC

Can you answer the following?

11

If Joe is nervous of bees why can’t we say he is suffering from a phobia?

What about Sophie being afraid of sharks?

There are 3 categories of Phobias: use the internet, text books etc to complete the following:

1. Specific phobia: intense, irrational fear of a particular item, situation.

Fear of a specific object or situation such as: - Arachnophobia – Claustrophobia – Aerophobia – Acrophobia – Alektorophobia – Androphobia – Carnophobia – Emetophobia – Phobophobia –

Fear becomes a phobia when it is maladaptive ie when it starts to interfere with everyday life.

Interesting fact: Specific Phobias affect about 10% of the population & more prevalent in females than males

2. Social phobia: persistent, irrational fear of social situations ie fear of being embarrassed or humiliated in a social situation.

Some sufferers fear meeting strangers or public speaking. They are afraid that someone will see them expressing their fear – by blushing, a trembling hand or a quavering voice and think badly of them. As a result they try to avoid certain social activities and situations.

a) Can be for specific situations: i.e. where person fears specific social situation eg, eating in public, speaking in public, panic attacks usually accompany this

b) Generalised social … less specific & person suffers social anxiety in most situations so involves fear of different types of social phobia eg initiating conversations, fear of speaking to authority figures, parties etc

Interesting fact: Social phobias tend to develop in late childhood/early adolescence & affect approx 11% men & 15% women (Kessler et al)

12

Watch youtube clip: social anxiety: Julie part 2 http://www.youtube.com/watch?v=6NBkwRhRC58 - note down 3 examples of what made her uncomfortable when she was in social places:

..

..

..

3. Agoraphobia: fear of a public place, or in some cases a fear of having a panic attack in a public place

Approx 2-3% of the population suffer from this, mainly females.

At first sight agoraphobia appears to be another social phobia. However, in most cases it begins with a series of panic attacks.

The sufferer has a feeling of impending doom and often fears dying, going mad or losing control. As a result they are afraid of having a panic attack in a place where they don’t feel safe and where there may be nobody around to help them. Where social phobics are afraid of others watching them, agoraphobics are fearful for themselves. Safety, rather than embarrassment is their main concern.Agoraphobia as a complication of panic attacks… where they are anxious about having a panic attack in a public place which they can’t escape so they avoid situations in case they panic & in severe cases, they don’t go out.

Agoraphobia without panic attacks… which is less common & characterised by a fear of the environment outside the home, which spreads and gradually increases in severity so the person can eventually become housebound.

Watch social phobia Julie part 4 & explain her difference between social anxiety and a panic attack http://www.youtube.com/watch?v=xwhRYPbUBiU

TaskRead the case studies below and decide whether they are examples of Specific phobias, Social phobias or Agoraphobia.

1. At the end of March each year, I start getting agitated because summer is coming and that means thunderstorms. I have been afraid since my early twenties, but the last three years have been the worst. I have such a strong heartbeat that for hours after a storm my whole left side is painful. I say I will stay in the room, but when it comes I am a jelly, reduced to nothing. I have a little cupboard and I go there, I press my eyes so hard I can’t see for about an hour and if I sit in the cupboard for over an hour, my husband has to straighten me up.’

13

OBB pg 203GHG pg 140

2. Edith is afraid of writing her name in public. She can’t use cheques or credit cards to shop or to eat in a restaurant. She no longer plays golf because she can’t sign the golf register. She can’t sign any papers that require approval of a notary public and she can’t vote because she can’t sign the voting register.

3. ‘Seeing a spider makes me rigid with fear, hot, trembling and dizzy. I have occasionally vomited and once fainted in order to escape from the situation. These symptoms last three or four days after seeing a spider. Realistic pictures can cause the same effect, especially if I inadvertently place my hand on one.’

4. One ordinary day while tending to some chore, taking a walk, driving to work – in other words, just going about his usual business – Leo Green was suddenly struck by a wave of awful terror. His heart started pounding, he trembled, he perspired profusely, and he had difficulty catching his breath. He became convinced that something terrible was happening to him – maybe he was going crazy, maybe he was having a heart attack; maybe he was about to die. As the attacks became more frequent, he began to avoid situations where he had experienced an attack, then others where he might find it particularly difficult to cope with one by escaping and getting help. He started by making minor adjustments to his habits – going to a supermarket at midnight, for example, rather than on the way home from work when the store tended to be crowded. Gradually Leo Green got to the point where he couldn’t venture outside his immediate neighbourhood, couldn’t leave the house without his wife, or sometimes couldn’t leave at all. What started out as an inconvenience turned into a nightmare. Like a creature in a horror movie, fear expanded until it covered the entire screen of his life.

5. ‘The minute I entered a restaurant it was a complete nightmare. I would sit down and feel the sweat pouring off me. Then my heart would start racing and I’d go redder and redder. It’s something about eating in front of people – I’m convinced they’re watching and judging me.’ Alice also had trouble travelling on the tube and would react suddenly with hot flushes, sweating and palpitations. ‘I only had to cough and it would trigger all my symptoms – I was convinced the whole train was looking at me. After that the blushing and sweating would start.’

Depression:

Define it…

There are no laboratory tests to diagnose depression so doctors diagnose from behaviour and what patients tell them. This means that it is difficult for doctors to distinguish between the least severe cases of depression and a bad attack of ‘the blues’.

You need to be able to describe behavioral, emotional and cognitive characteristics of Depression:

Key behavioral characteristics/symptoms:

14

OBB pg 197GHG pg 142

Key emotional characteristics/symptoms:

Key cognitive characteristics/symptoms:

Fill in the questionnaire provided and score it.

This questionnaire was devised by Aaron Beck to assist health care professionals in the diagnosis of depression. Don’t worry a high score doesn’t necessarily mean you are depressed. This questionnaire has a lot of weaknesses and limitations.

Why do you think it may not be a reliable instrument for diagnosing depression?

In reality it would be used as one amongst many other diagnostic tools by health care professionals.STATISTICS: According to MIND 2.6% of the UK population suffers from Clinical Depression. DSM V distinguishes between major depressive disorder and persistent depressive disorder which is long term and/or recurring.

Emotional characteristics of DepressionSadnessAngerLoss of interest or pleasure in usual hobbies or activities

Behavioural Characteristics of DepressionShift in activity level (either reduced or increased energy)Sleep (either reduced or increased)Appetite (either reduced or increased)

Cognitive Characteristics of DepressionNegative and irrational thoughts

Obsessive Compulsive Disorder (OCD)

15

Definitions and symptoms: OCD occurs in 2% population & equal numbers of Ms & Fs…usually starts adolescence/early childhood but can start in childhood.

Why is it called OCD? It is characterised by:

a) Obsessions: which are… persistent, recurring thoughts/ideas/images/impulses intruding into one’s mind.

These..occur automatically

Are unwantedDisturbing to the individual…cause feelings of panicExcessive worries unrelated to real life problemsSignificantly interfere with the ability to function on a day-to-day basis as they are incredibly difficult to ignore

b) Compulsions: which are…Repetitive behaviours/rituals compelled to perform to reduce the anxiety of the obsessions, e.g.g scrubbing hands hundreds of times to get rid of germs…the individual knows it’s unreasonable but they are compelled to do it

Most common: washing/checking/countingWashers worried about contamination & avoid touching handles/shaking hands etc & spend hours washing to reduce anxiety

About 20% people with OCD only have obsessions…(not accompanied by the compulsion to carry out the act) & these obsessions often concern causing harm to loved ones

People with OCD often realise that their obsessional thoughts are irrational, but they believe the only way to relieve the anxiety caused by them is to perform compulsive behaviours, often to prevent perceived harm happening to themselves or, more often than not, to a loved one.

Compulsions are repetitive physical behaviours and actions or mental thought rituals that are performed over and over again in an attempt to relieve the anxiety caused by the obsessional thoughts. Avoidance of places or situations to prevent triggering these obsessive thoughts is also considered to be a compulsion. But unfortunately, any relief that the compulsive behaviours provide is only temporary and short lived, and often reinforces the original obsession, creating a gradual worsening cycle of the OCD.

It has traditionally been considered that there are four main categories of OCD. Although there are numerous forms of the illness within each category, typically a person’s OCD will fall into one of the four main categories:

1. Checking

16

OBB pg 191GHG pg 144

2. Contamination / Mental Contamination3. Hoarding4. Ruminations / Intrusive Thoughts

The Behavioural, Emotional and Cognitive characteristics of OCD The cognitive aspect of OCD is obsession, the constant thoughts OCD sufferers’ experience which

take the form of persistent and uncontrollable thoughts, images, impulses, worries, fears or doubts.

The behavioural aspect is the compulsive behaviours which they are unable to control.

The emotional aspect is the concern and upset caused by the knowledge that their obsessions and behavior are irrational and abnormal. Sufferers recognize that their obsessions and compulsions are irrational, but feel powerless to control them.

The Behavioural approach to explaining the causes of Phobias and the treatment of

Phobias

Behavioural explanation to explaining phobias

Behavioural causes: Classical Conditioning – learning by association, when two stimuli are paired together repeatedly

we learn to associate them with the same response even when they appear alone.

Operant conditioning – we learn behaviours as a consequence of positive of negative consequences.

Behavioural treatments: Systematic desensitisation

Flooding

REMEMBER: Difference/distinction between these:

Obsession: unwanted, unbidden thoughtCompulsion: repetitive act driven to perform in order to dispel anxiety associated with obsessive thought

17

Most people have fears of certain things e.g. spiders or situation e.g. public speaking. However, a fear only becomes a phobia when it begins to affect the person ability to live a normal, everyday life.Phobias are seen as learnt behaviour, either through classical conditioning, operant conditioning or social learning theory.

This is a 2 process theory as it involves learning through:i) Classical conditioning (learn the phobia) ii) Operant conditioning. (maintain it)

Classical conditioning: eg that the person has learnt to fear something ie a neutral stimulus if it is paired with a frightening event (the unconditioned stimulus). This means they have learnt by association.

Give your own example in space below

Classical Conditioning – Watson & Rayner (1920) conditioned a baby boy known as Little Albert to fear white rats.

For several weeks, Albert played happily with a white rat showing no fear. One day, while he was playing with the rat, the experimenters struck a steel bar with a hammer close to Albert’s head. Albert was very frightened by the noise. This was repeated each time he reached for the rat. Albert then developed an intense fear of white rats (and Dr. Watson!).

UCS (Noise) UCR (Fear)

UCS (Noise) + NS (Rat) UCR (Fear) after many pairings

CS (Rat) CR (Fear)

NB note NS = neutral (not conditioned yet!)

Advice: when trying to work out these, it is often easier to start with the bottom line first & work backwards. The CS will always be the NS in the middle line, so then you need to work out what the UCS would be in the top line

Before Conditioning:

Someone’s scream makes you afraid/ fearUCS UCR

During Conditioning :

scream + spider fearUCS & NS UCR

After conditioning

spider fear CS CR

18

2 process theory: part ii) Operant conditioningThe idea is that the learned fear is then maintained by operant conditioning because fear is reduced when we avoid the object and so we are being reinforced through negative reinforcement.

Remind yourself here of the definition of negative reinforcement...)

Part of negative reinforcement is known as avoidance conditioninge.g. Watson & Rayner’s rat experiment with Albert…once Albert avoided rats, his fear was reduced which meant he was being reinforced to avoid them again.Operant Conditioning. This refers to learning to behave in certain ways because the behaviour is reinforced, by some sort of positive outcome or removal or avoidance of something negative. In terms of phobias, avoidance of the phobic object or situation is reinforced by the reduction of anxiety.

Avoidance maintains the fear and preserves the phobia. Frequent contact with a phobic object may reveal that it is harmless, which will lead to the extinction of the phobia. However, people with phobias go to great lengths to avoid the object of their fears, often planning ahead and putting up with all manner of inconvenience.The Two-Process Theory argues that phobias are acquired through classical conditioning but are then maintained through operant conditioning.

Using you text books, evaluate the behaviourist explanation of Phobias: remember as an explanation, you need to consider CASTLES: these can be brief notes

CAS TLES

Behaviourist approach Treatment for phobias:

Behavioural therapies are based on the ideas of classical and operant conditioning. Behavioural therapies aim to change specific behaviours. They assume that both ‘normal’ and ‘abnormal’ behaviours are learnt.

Behaviour therapy – Classical Conditioning.Behaviour therapy is often used to treat Phobias. It assumes that: -

19

1. Phobias are learnt by classical conditioning and 2. They can be unlearnt by a similar process.

Phobias can be removed by counter-conditioning – learning a new response to the feared stimulus. This is the principle behind Systematic Desensitization.

1. Systematic desensitization: This approach was developed by Joseph Wolpe (1958). This is based on the idea that 2

competing emotions can’t occur at the same time. “reciprocal inhibition” So Fear is replaced with relaxation. Fear & relaxation can’t occur at the same time. The relaxation is the desensitization part.

Imagine you are a therapist helping a client overcome a fear of flying. Construct a fear hierarchy for flying, with at least 6 items. Explain

how you would help a client through their fear using this hierarchy.

What is your fear? Design a fear hierarchy for your own phobia.

Flooding therapy This approach directly exposes clients to the objects or situations they fear. It hits them hard. For

example, someone with a fear of heights is taken to the top of a tower block and encouraged to stay there. In theory, flooding the client – exposing them repeatedly to the feared stimulus – will allow them to see that although they feel sick and are terrified, they (usually!) survive this and the fear eventually

It takes clients through the following steps:Step 1 – Clients are taught relaxation techniquesStep 2 – With the help of a therapist, clients construct a fear hierarchy – a list of feared objects or situations ranked from the least to the most feared. E.g. a person with arachnophobia might imagine a spider in various situations from a picture in a book (least feared) to crawling over their hand (most feared).Step 3 – In the presence of the therapist, the client then confronts each item in the hierarchy while they are in a state of deep relaxation. They start with the least feared item and move on once they feel relaxed and unafraid in its presence. This confrontation may be real or imagined. The process continues until they reach the top of the hierarchy and feel relaxed in the presence of all the items. If the systematic desensitisation works, clients have been counter conditioned – they have learnt a new response to a stimulus. They no longer associate the object or situation with fear.

Can be carried out either actual exposure or just imagining & recently virtual reality exposure has been used (VRET)

20

disappears. They survive so they realise there is no basis for their fear. If the therapy works, this leads to the extinction of the fear.

Watch “woman is afraid of clowns (see Coulrophobia clip (fear of clowns))https://www.youtube.com/watch?v=1h3Dh5QAD7w The Steps here are:

o Patients are exposed to the thing that causes anxiety eg room of snakes etco Patients are usually overwhelmed and very anxious but eventually this subsideso Patients recognise anxiety drops & that they don’t need to avoid that situation again

We can also use Implosion therapy: same as flooding but asked to imagine only

Implosion TherapyThis is a variation of flooding. Rather than physically facing the fear stimulus, clients are asked to imagine it. With the help of a therapist the client is asked to create and experience a fear situation in their imagination.

Implosion therapy aims to show clients that their fears are groundless. After several sessions facing their worst fears, some realise their fears are groundless and their fears disappear (implode) or are reduced in intensity

Stretch and Challenge:Virtual reality exposure therapy: using the idea of systematic desensitisation

o Based on principles of SD but therapy takes place in a virtual worldo P’s put in a 3D world…..head mounted display allows sensory cues to be picked upo Computer monitor shows the therapist what the patient sees o So for eg with a fear of flying:

Patient wears head gear so put into virtual cabin with real sensory cues to make it seem real

Gradually exposed to hierarchy of situations similar to SD eg sitting down in their seat, then engines start, then taxiing down the runway, taking off, landing etc

P’s rate their anxiety on a scale. Through this, they find their anxiety decreases until no longer fear flying even in a

real plane.

watch youtube clip of this: Virtual reality treatment for anxiety

http://www.youtube.com/watch?v=3ppm2lhpkXs

Can you spot any strengths or weaknesses with this?

21

Evaluation of Behavioural treatments:

1. Flooding is an extreme form of therapy and therefore rather ethically dubious. Clients find it very frightening and discomforting. Because of this many therapists only use it as a last resort, when other treatments have failed.

2. Despite this, it can be helpful. People with specific phobias can lose their fear after only 3 sessions of flooding (Marks 1987)

However, watch “my extreme animal phobia tough guy afraid of a puppy”

Then Maury show, woman afraid of balloons http://www.youtube.com/watch?v=Lh5pKGG9q6o

Can you identify any ethical issues?

Evaluation1. Implosion therapy is more ethical than flooding2. However, it is also generally less effective than flooding.

Using you text books, evaluate whether this treatment is effective and whether it is appropriate. Think about the following:Can the treatment be used for all types of phobias? Any evidence / research to support it?

Is it cost effective? Can it be applied to day to day life easily? Any ethical issues?

22

OBB pg 203GHG pg 148

The Cognitive approach to explaining and treating depression

Reminder:

Beck’s Cognitive TriadEllis’s ABC Model

Beck’s Cognitive behavioural therapy (CBT)Ellis’s CBT known as Rational Emotive Behaviour Therapy (REBT)

Abnormality is caused by irrational thought processesHow people perceive, reason and judge the world around them are at the root of many disorders.Cognitive distortions (dysfunctional thought processes) are evident in depression.

The individual is the cause of their own behaviour because they control their own thoughts.Is there an ethical issue with this?

Cognitive explanations for depression

Cognitive treatments for depression

23

The Cognitive approach focuses on how thinking shapes our behaviour. Depression is seen as being caused by negative and irrational thought processes.Aaron Beck’s Negative Triad (1967)

This approach to explaining depression is based on the concept of schemata. Basically, it suggests that depression is the result of holding negative schema about the world, the self and the future.

The Self: - ‘I’m undesirable’The World: - ‘I understand why everybody hates me, everyone else is so much better than me’The Future: - ‘Things will never change for me’

This pessimistic view becomes a self-fulfilling prophecy and lead to cognitive bias. Depressed people tend to focus on the negative aspects of their lives and ignore the positive ones; therefore they become trapped in a vicious circle of depression.

1. Give examples of negative or irrational thought patterns which people may have.

Using OBB, complete the following 2 tasks: Becks errors of logic / cognitive distortions

COGNITIVE DISTORTIONS / BIAS

DESCRITPTION

Overgeneralisation

Personalisation

Minimisation

24

Magnification

Selective abstraction

According to Shahar et all (2008) what are the 3 types of negative self schema?1.

2.

3.

Ellis’ ABC Model (1962)

Albert Ellis also focuses on irrational beliefs as the source of depression. It is not what happens to someone that causes depression, but how they deal with it.

Task: - Evaluate cognitive explanations of depression

STRENGTHS WEAKNESSESS

25

The Cognitive approach to treating Depression;

Beck’s CBT (Cognitive Behavioural Therapy)

Ellis’s CBT – called Rational Emotive Behavioural Therapy (REBT)

Cognitive Treatments for DepressionThe cognitive approach to treating depression is Cognitive Behavioural Therapy (CBT). Probably the first treatment that comes to mind for depression is anti-depressants. However, these only treat the symptoms and not the cause. In order to treat depression, you need to discover the root cause, which may lie in the way people think about the world and themselves. CBT tackles the person’s thought processes and aims to address the negative or faulty thoughts.

CBT aims to change the way a client thinks, by challenging irrational and maladaptive thought processes and this will lead to a change in behaviour as a responses to new thinking patterns. Most CBT Therapists draw on both Ellis’s and Becks models of depression.

1. CBT focuses on challenging the negative thoughts about oneself, the world and the future (Beck’s negative triad). These thought can be directly challenged and the client is encouraged to test the reality of their negative beliefs.

2. CBT focuses on: -Affect – How a client feelsBehaviour – How they actCognition – How they think

3. CBT is not an easy option; it can be expensive and time consuming. The patient must be motivated and really want to change. It also relies on a good relationship being formed between the client and therapist.

Evaluate CBT treatment: effectiveness and appropriateness for Depression#

Using pg 207 in OBB make some evaluative points. There is also the study by Christensen et al (2004) that can be referred to in your evaluation

STRENGTHS:

WEAKNESSES:26

Ellis’ Rational emotive therapy (REBT):

A = Activating Event: e.g. getting fired from your job, death of a family member

B = Belief: these can be rational or irrational e.g. ‘I lost my job because they were overstaffed’ or ‘They always had it in for me’

C = Consequence: Rational beliefs lead to healthy emotion responses, whereas irrational beliefs lead to unhealthy ones and result in depression.

So Rational Emotive therapy was devised from Ellis’ ABC model ie altering irrational beliefs to rational

ELLIS’S “THREE MUSTS”

1.

2.

3.

27

AO3

This model is an extension of Ellis’ ABC model which is used to explain depression.

D = Disputing irrational thoughts and beliefs, the therapist challenges them and encourages the client to think of alternative explanations or possibilities

E = Effects of the new beliefs and attitudes that emerge

F = Feelings the emotional responses that arise

Both REBT and CBT will set clients homework tasks which may involve putting themselves into situations which they would have previously avoided or telling a family member or friend how they really feel. Another key element is behavioural activation where they client is encourage to become more active and take part in pleasurable activities. Physical activity naturally lift mood and many depressed people no longer participant in physical activities. Ellis strongly believed in the importance of unconditional positive regard, a humanist ideal. This involved convincing the client of their own self-worth and encouraging them to love themselves!

Task: - Complete the table using the ABC Model for two responses to the same negative event e.g. failing your driving test.

A – Failing your driving test

B Rational belief B Irrational belief

C Healthy Negative Emotion

C Unhealthy Negative Emotion

AO2

28

OBB pg 197GHG pg 152

Ensure you have a full evaluation of both treatments

Task: there is a lot of research looking at the cognitive treatments to Depression. These studies can support your evaluation and are vital to get your high grades. Read OBB and GHG and add these studies to your Psychopathology Research Bank

The Biological approach to explaining and treating OCD

What causes OCD? We need to study only the Biological explanations now:

Biological Explanations: The biological approach assumes that abnormality is caused by physiological factors such as brain biochemistry, neuroanatomy (brain structural abnormalities) and genetics. Treatments that alter physiology such as drugs are used to address the disorder.There are different aspects to a biological explanation so be careful: you should be clear about which you are using.

1. Genetic:…ie that there is a genetic predisposition meaning that someone inherits something that makes them vulnerable to developing OCD

Evidence for this:a. Evidence from family studies …patients with OCD are more likely to have a 1st degree

relative with an anxiety disorder eg Nestadt et al. (2000) found much higher % (11.7 %) OCD sufferers in relatives of OCD patients than in a control group of non OCD sufferers (2.7%)

Using your text books: what other research has supported this explanation?

Twin studies:

Miguel et al (2005):

b. Outline candidate genes concept…..

29

AO3

c. OCD seems to be polygenic meaning….. Eg Taylor believes….

Evaluate the genetic evidence

d. Neural explanation:

Neural Explanations– Genes are likely to affect levels of neurotransmitters (brain biochemicals) as well as structures of the brain

There is evidence from PET scans that people with OCD have areas of abnormality within their brains. The orbitofrontal cortex (OFC) sends signals to the thalamus about potential ‘worries’ e.g. germ alert, usually these minor worries are suppressed by the caudate nucleus. However, if the caudate nucleus is damaged, the worry is not suppressed and the thalamus is alerted and confirms the worry to the OFC. This creates a ‘worry curcuit’ which leads to obsessive thoughts.

Serotonin and Dopamine are linked to these regions of the frontal lobe and are implicated in the malfunction of the caudate nucleus. Sukel (2007) found that the main neurotransmitter of the basal ganglia is dopamine and high levels of dopamine lead to over activity in this area of the brain. Genes associated with OCD are likely to affect levels of neurotransmitters as well as structures in the brain. Most anxiety disorders respond to various drugs but OCD only responds to drugs affecting the neurotransmitter serotonin, which suggests OCD is related to low levels of serotonin. Drugs which increase the amount of serotonin in the brain eg SSRI anti depressants also reduce OCD symptoms…therefore implying OCD could be due to low serotonin

Again there is lots of research in both text books… add these to you research bank

Evaluation: - Although family and twin studies find some evidence for OCD being an inherited disorder, the concordance rates are never 100%. This means that we cannot rule out the possibility that OCD is a learnt disorder.

30

OCD can also be explained by the two-process theory we looked at in our explanations of Phobias. The Two-Process Theory argues that phobias are acquired through classical conditioning, but are then

maintained through operant conditioning.

Task: - Apply the two-process theory to OCD.

Evaluation of Neural explanations of OCD:

Identify whether the evaluation points below are strenths or limitations of the neural explanation:

Depression is often co-morbid (present) with OCD, when more than one disroder is present in a

person this is known as co-morbidity. Disruption of serotonin levels is also present in depressed people so we are not sure whether the causes of OCD are due to disruption of serotonin levels or whether the disruption is caused by the depression.

There is evidence that other neurotransmitters are disrupted in the brain of people with OCD however it is unclear whether disrupted levels of neurotransmitters caused OCD or whether the OCD caused a disruption in neurotransmitters.

Drugs that act on serotonin are effective in treating OCD, suggesting that serotonin is involved in OCD.

Studies of neuroanatomy (brain structures) are highly scientific using the latest technology and have shown that the neural systems that function in decision making function abnormally in people with OCD. However other brain systems may also play a part, we are yet to find a brain system that ALWAYS plays a part, therefore our understanding of neural mechanisms involved in OCD still has some way to go.

OCD symptoms are also preent in other disorders that we know have a bilogiicl basis such as Parkinson’s Disease – this suggests that OCD itself is biolgical in origin too.

Other useful evaluative points:

1. It is difficult to untangle genetic and environmental causes and family studies could also be explained by learning theories like SLT, ie that OCD is due to …….

2. Drugs like SSRIs which increase the amount of serotonin in the brain provide only a partial remission for OCD, and most objective empirical studies only report 50% improvement with these drugs.

3. what this means is there must be other explanations for OCD eg……………. which might be better explanations

4. The therapeutic effect of SSRI drugs (ie that it can relieve some symptoms of OCD) doesn’t necessarily mean it is the cause of OCD

5. In other words, for eg paracetemol relieves a headache but not having daily paracetemol doesn’t mean you will get a headache. So, just because SSRI drugs relieve symptoms, doesn’t mean serotonin levels cause OCD and, again, there could be a different factor causing OCD

6. Another problem with the biochemical explanation is the time delay before improvement in OCD, as taking SSRI medication increases serotonin levels in the brain within hours, but the improvement in behaviour (a clinical response) takes approx 4-12 weeks. If serotonin levels was the cause of OCD, this can’t be explained in this way.

AO2

31

7. The neurophysiological idea based on neuroimaging research was that OCD sufferers have a different basal ganglia, but other research did not find any structural differences in the basal ganglia of OCD patients compared with a control group of non OCD sufferers.

8. In other words, even if the basal ganglia is implicated, it only explains some of the behavioural components of OCD like repetitive acts not obsessional thoughts.

So, how do we treat OCD?

Biological Treatments for OCD ie drugsMain treatment based on the assumption that it is a bio chemical imbalance (neurotransmitters which cause the abnormality). Drugs can INCREASE and DECREASE levels of neurotransmitters.

Because depression often accompanies OCD, these drugs are particularly useful for OCD

When neurotransmitters are released into the synaptic gap, not all of it attaches to the receptor sites on the receiving neuron.The remaining neurotransmitter must be removed to allow the synapse to return to its normal state. This is done by 2 ways:

Pumped back into the pre-synaptic neuron by a re-uptake pump in the synapse

Broken down into a different substance by an enzyme.

Drugs which INCREASE the levels of the neurotransmitter

(SSRIs (selective serotonin reuptake inhibitors) are a group of anti-depressant medications such as Prozac. (these SSRIs prevent serotonin being reabsorbed)

What do they do?They increase the levels of the neurotransmitter serotonin in the brain by inhibiting the amount of serotonin reabsorbed at synapses. )

MAO Inhibitors…are an older class of anti- depressant which are sometimes used for those who don’t benefit from SSRIs. (v. basically MAOs destroy serotonin so MAO inhibitors stop MAOs destroying serotonin)

Gava et al (2007) found the most common treatment for OCD was drugs.

Antidepressants, also known as SSRIs (Selective serotonin re-uptake inhibitors) are the drug of choice for OCD. These work by blocking serotonin receptor sites on neurons and thereby increase the amount of serotonin in the synapse. Brand names include Zoloft, Paxil and Prozac.

SSRIs (selective serotonin reuptake inhibiters) are prescribed for OCD because low levels of serotonin are thought to cause this disorder.SSRIs (e.g. prozac) block the re-uptake pump in the synapse. This reduces the rate of re- absorption, therefore increasing serotonin levels by allowing more serotonin to attach to receptors.

32

Alternative drugs to SSRI’sOccasionally when patients do not respond to SSRI’s and/or CBT, other drugs may be used to help tackle the OCD symptoms.

Another type of common antidepressant used to treat OCD is tricyclics. Tricyclics work on both serotonin and noradrenaline. These work on more than one neurotransmitter, but this increases the side effects, so are only used when SSRIs have failed.

Anti-anxiety drugs such as Librium, Xanac, Valium and Diazepam slow down the activity of the central nervous system. They do this enhancing the activity of GABA (gamma-aminobutyric acid) this has a generalized quietening effect on the neurons in the brain. Basically, shutting down the ‘worry circuit’.

Evaluation: how effective are Bio treatments? Think…. Cost effective? Any side effects?

Strengths Weaknesses

Extra summary points:Positive points:SSRIs

are easily tolerated for most people safe even with older patients not addictive can be used long term Drug treatment is also quicker & cheaper than psychological treatments.

Negative33

However SSRIs can cause side effects eg headaches, nausea, sexual dysfunction with some people so there are these risks attached

There is also a risk of relapse when coming off it, which means………... so, often a combined drug & psychological treatment is used in preference, which seems to be more effective

Also it takes 4-12 weeks of taking these SSRIs before any therapeutic benefit is noticed & therefore sometimes patients will believe they are not effective and abandon them, particularly those suffering from the side effects.

Exam Questions (AS)

1) Read the item and then answer the questions that follow.

Researchers analysed the behaviour of over 4000 pairs of twins. The results showed that the degree to which obsessive-compulsive disorder (OCD) is inherited is between 45% and 65%.

Distinguish between obsessions and compulsions. [2 marks]

2. With reference to the study described above, what do the results seem to show about possible influences on the development of OCD? [4 marks]

3) Read the item and then answer the question that follows.

Steven describes how he feels when he is in a public place.

‘I always have to look out for people who might be ill. If I come into contact with people who look ill, I think I might catch it and die. If someone starts to cough or sneeze then I have to get away and clean myself quickly.’

Outline one cognitive characteristic of OCD and one behavioural characteristic of OCD that can be identified from the description provided by Steven. [2 marks]

34

4) Complete Figure 2, below, by filling in A and B, to show Beck’s negative triad as it is used to explain depression.

Figure 2: Beck’s negative triad

Negative views about

A………..

e.g. ‘I’m worthless’

Negative views about

B………..

e.g. ‘I will never be any good at anything.’

Negative views about

C the world

e.g. ‘Nobody values me.’

[2 marks]

5) Briefly outline one strength of the cognitive explanation of depression. [2 marks]

6) Outline and evaluate the behavioural approach to treating phobias. [12 marks]

1) Which two of the following are examples of Jahoda’s criteria for ‘ideal mental health’? Shade two boxes only. For each answer completely fill in the circle alongside the appropriate answer.

A Dependence on others

B Environmental mastery

C Lack of inhibition

D Maladaptiveness

E Resistance to stress

[2 marks]

35

2) Read the item and then answer the question that follows.

The following article appeared in a magazine:

Hoarding disorder – A ‘new’ mental illness

Most of us are able to throw away the things we don’t need on a daily basis. Approximately 1 in 1000 people, however, suffer from hoarding disorder, defined as ‘a difficulty parting with items and possessions, which leads to severe anxiety and extreme clutter that affects living or work spaces’.

Apart from ‘deviation from ideal mental health’, outline three definitions of abnormality.

Refer to the article above in your answer. [6 marks]

3) Read the item and then answer the question that follows.

Kirsty is in her twenties and has had a phobia of balloons since one burst near her face when she was a little girl. Loud noises such as ‘banging’ and ‘popping’ cause Kirsty extreme anxiety, and she avoids situations such as birthday parties and weddings, where there might be balloons.

Suggest how the behavioural approach might be used to explain Kirsty’s phobia of balloons. [4 marks]

36

4) Read the item and then answer the questions that follow.

Twenty depressed patients were treated using cognitive behavioural therapy. Over the course of the six-week treatment, each patient’s mood was monitored every week using a self-report mood scale (where a score of 20 = extremely positive mood and a score of 0 = extremely negative mood). Each week they also completed a quality of sleep questionnaire which was scored from: 10 = excellent sleep to 0 = very poor sleep.At the end of the study the researchers correlated each patient’s final mood score with his or her final sleep score. The results are shown in Figure 1 below. Figure 1: Scattergram to show the relationship between final mood scores and final sleep scores for 20 patients at the end of therapy

Outline the type of relationship shown in Figure 1 above and suggest why it would not be appropriate for the researchers to conclude that better sleep improves mood. [2 marks]

5) Outline one way in which the researchers should have dealt with ethical issues in this study. [2 marks]

37

6) The sleep questionnaire used by the researchers had not been checked to see whether or not it was a reliable measure of sleep quality. Explain how this study could be modified by checking the sleep questionnaire for test-retest reliability. [4 marks]

7) Outline cognitive behaviour therapy as a treatment for depression. [4 marks]

38

24 marks total

39