Psychopathology Revision


Part 1 — Definitions of Abnormality 


Definition 1  

Statistical infrequency = Implies that a disorder is abnormal if its frequency is more than two standard deviations away from the mean incidence rates represented on a normally distributed bell curve. 


Evaluation of statistical infrequency definition  ( A03)  

+ Objective=The mathematical nature of this definition means that it is clear what is defined as abnormal and what is not. 

Limited Explanatory Power= Statistical infrequency assumes that any abnormal characteristics are automatically negative, which is not always the case. For instance, abnormal levels of empathy (qualifying as a Highly Sensitive Person) or having an IQ score above 130 (being a genius) would not necessarily be negative. 


Definition 2 

The failure to function definition =The failure to function adequately of abnormality was proposed by Rosenhan and Seligman (1989) and suggests that if a person’s current mental state is preventing them from leading a ‘normal’ life, they may be considered as abnormal. 


Evaluation of Failure to function definition (A03) 

+ Empirical/Observable= If someone is not doing well, it's noticeable to people around them. For example, if they struggle to get out of bed or keep a job, others can see that. If the person can't make decisions or take care of themselves, others might need to step in to help. 

Cultural Relativism= Being able to handle daily life depends on what people consider normal. This can be different from one culture to another. For instance, some people naturally stay up late and don't wake up until noon, but they work well during other hours. In some cultures, taking afternoon naps or moving homes frequently might be normal, while in others, it could be seen as unusual. This makes it tricky to have a clear definition. 


Definition 3 

The Deviation from ideal mental health definition = This is an explanation of abnormality, suggesting that there are different theoretical ideas about what is considered 'normal.' If someone doesn't align with these theoretical norms, their behaviour is considered abnormal. 

One example of a theoretical description of abnormality comes from Marie Jahoda in 1958. She proposed six criteria for ideal mental health or 'normality.' These criteria are as follows: 

  • Positive Attitude towards the Self: 
  • Connected to a person's self-esteem. Ideal mental health requires a good level of positive attitude, ensuring the individual feels content with themselves. 


Being in a state of contentment, feeling that one has reached their fullest potential. 



Independence and self-reliance, the ability to function as an individual without depending on others. 


Resistance to Stress 

The individual should not feel overwhelmed by stress and should be capable of handling stressful situations competently. 


Environmental Mastery 

Adaptability to new situations and ease in handling various life circumstances. 


Accurate Perception of Reality 

Focuses on how the individual sees the world. Ideal mental health requires a perspective similar to how others perceive the world, addressing distortions of thinking that some individuals, like those with schizophrenia, may experience. 

Jahoda emphasised that for ideal mental health, an individual should meet all these criteria. If some are not fulfilled, difficulties may arise for the person. 


Evaluation of the Deviation from ideal mental health definition (A03) 


+Idiographic Approach= From an idiographic perspective, a notable advantage lies in the capacity of this definition to facilitate personalised intervention for an individual encountering challenges in aligning with societal norms. Consider a scenario where targeted measures can be implemented to address distorted thinking, thereby aiding the individual in transitioning their behaviour towards a more normalised state. This approach acknowledges the interconnected nature of cognition and behaviour, recognising that rectifying biased thinking can contribute to the normalisation of corresponding behaviour. 


— Ethnocentrism=The idea of autonomy, or independence, may make collectivist cultures – where people focus on the greater good and working together – seem different. In many Western cultures, which are more individualistic, Jahoda's criteria make sense. But for non-Western cultures, these criteria might not make as much sense. This means the definition isn't suitable for everyone around the world. 


Definition 4 

The Deviation from social norms definition= This is one way to describe abnormal behavior. Basically, abnormality is when someone's actions don't match what is considered okay in a particular society. For instance, in the UK, it's normal to stand in line at a store and wait for your turn. If someone skips the line and goes straight to the cashier, people would see it as abnormal based on this definition. 


Evaluation of the The Deviation from social norms definition (A03) 

+Real World Practical Applications= Abiding by social norms implies that society is structured and predictable. This is considered to be advantageous. 

For instance, when individuals follow traffic regulations, it enhances road safety as everyone knows what to expect. This notion of order and predictability is viewed as beneficial for the overall well-being of society. 


—Cultural Differences= The diversity across cultures can pose a weakness for this definition, as it's not always evident what is considered abnormal or normal in different societies. Deciding what is abnormal often requires immersing oneself in the culture for a period to make an informed judgment. 


Part 2 — Characteristics of Phobias 

Behavioural Characteristics 

-The behavioural characteristics of phobias include panic, avoidance, and endurance. 

-Panic results from heightened physiological arousal triggered by the hypothalamus in response to the phobic stimulus. 

-Avoidance behaviour is negatively reinforced through classical conditioning, impacting the patient’s daily life. 

-Endurance occurs when the patient remains exposed to the phobic stimulus for an extended period, experiencing heightened anxiety. 


Emotional Characteristics 

-The main emotional characteristics of phobias are anxiety and an unawareness that the anxiety towards the phobic stimulus is irrational. 


Cognitive Characteristics 

-Cognitive characteristics include selective attention, irrational beliefs, and cognitive distortions. 

-Selective attention involves the patient focusing on the phobic stimulus, often due to irrational beliefs or cognitive distortions. 


Part 3 — Characteristics of Depression 

Behavioural Characteristics 

-Behavioural characteristics include changed activity levels, aggression, and altered sleeping and eating patterns. 


Emotional Characteristics 


-Emotional characteristics include lowered self-esteem, persistent low mood, and high levels of anger. 


Cognitive Characteristics 

Cognitive characteristics involve absolutist thinking, selective attention to negative events, and poor concentration. 


Part 4 — Obsessive-Compulsive Disorder (OCD) 

Behavioural Characteristics 

-Behavioural characteristics include compulsions and avoidance behaviour. 


Emotional Characteristics 

-Emotional characteristics encompass guilt, disgust, depression, and anxiety. 


Cognitive Characteristics 

-Cognitive characteristics involve acknowledging excessive and irrational anxiety, developing cognitive strategies, and experiencing obsessive thoughts. 


Part 5 — Behavioural Approach to Explaining Phobias 


The behaviourist approach sees all behaviour as observable and learned. When explaining phobias, it focuses on the behaviours without considering cognitive or emotional aspects. 

Mowrer's two-process model explains the development and persistence of anxiety disorders, including phobias. According to Mowrer (1960), phobias are initially acquired through classical conditioning, where a neutral stimulus (NS) becomes associated with an unconditioned stimulus (UCS), resulting in a conditioned response (CR) of fear. This conditioning generalises to similar objects. 

Maintenance of phobias occurs through operant conditioning. Avoiding the phobic stimulus reduces anxiety, acting as a reward. Operant conditioning reinforces avoidance behaviour by reducing anxiety, perpetuating the phobia. 


Evaluation of the Behavioural Approach to Explaining Phobias  (A03) 

+ Supporting Study= In 1920, Watson and Rayner conducted an experiment involving an 11-month-old boy named Little Albert. Initially, Albert was a calm child without any fears. The researchers aimed to instill a phobia of rats by exposing Albert to a rat and simultaneously striking a steel bar behind his head to create a loud noise. This procedure was repeated three times, and the same was done a week later. Subsequently, when Albert was shown the rat again, he started crying. Through these actions, Watson and Rayner successfully conditioned a fear response in Albert using classical conditioning. 

— Limited Explanatory Power= The two-process model overlooks cognitive factors. For instance, irrational beliefs could lead to the development of a phobia without the necessity of a frightening encounter. 


Part 6: Behavioural Approach to Treating Phobias 

Treatment 1: Systematic Desensitisation  

Systematic desensitisation employs reverse counter-conditioning, aiming to unlearn maladaptive responses to a situation or object by eliciting an alternative response, namely relaxation. The therapy comprises three crucial components: 

  • Fear Hierarchy: The client and therapist collaboratively establish a fear hierarchy, ranking the phobic situations from least to most terrifying. 
  • Relaxation Training: Individuals are taught relaxation techniques, such as breathing exercises, muscle relaxation, or mental imagery. 
  • Reciprocal Inhibition: The final step involves exposing the patient to their phobic situation while in a relaxed state. 

According to systematic desensitisation, the theory of reciprocal inhibition suggests that two emotional states cannot coexist simultaneously. As a result, the goal is for relaxation to supersede fear. The patient starts at the lowest level of the fear hierarchy, progressing to the next level when they can remain relaxed in the presence of the stimulus. The patient continues this process until they can stay completely relaxed in the most feared situation, marking the success of systematic desensitisation. 


Evaluation of the Behavioural Approach to Treating Phobias  (A03) 

+Supporting Study= McGrath et al. (1990) discovered that 75% of patients with phobias were successfully treated using systematic desensitisation, specifically with in vivo techniques. This indicates the effectiveness of systematic desensitisation in treating phobias. 


— Appropriateness= Systematic desensitisation is not effective in treating all phobias. Patients with phobias that have not arisen from personal experiences, such as a fear of heights developed through classical conditioning, are not successfully treated using systematic desensitisation. Some psychologists argue that specific phobias, like the fear of heights, may have an evolutionary survival benefit rather than stemming from personal experiences but are a result of evolution. These phobias underscore a limitation of systematic desensitisation, particularly its ineffectiveness in treating evolutionary phobias. 


Treatment 2: Flooding  

A more intense form of behavioural therapy is flooding. Instead of gradually exposing an individual to their phobic stimulus, flooding involves immediate exposure to the most frightening situation. 

For instance, someone with a dog phobia would be placed in a room with a dog and asked to stroke the dog right away. 

With flooding, individuals cannot avoid their phobia (and negatively reinforce it), and through continuous exposure, anxiety levels decrease. 

Flooding can take one of two forms: 

  • In vivo (actual exposure): Direct exposure to the feared situation. 
  • In vitro (imaginary exposure): Imagined exposure. 

Patients are taught relaxation techniques, and these techniques are then applied to the most feared situation either through direct exposure or imagined exposure. 


Evaluation of flooding (A03) 

+Practical Applications (Practicality)= An advantage of flooding lies in its cost-effective nature as a treatment for phobias. Research, such as that by Ougrin in 2011, has indicated that flooding is on par with other treatments like systematic desensitisation and cognitive therapies, but it is notably quicker. This efficiency is a strength because it allows for a speedier treatment of patients, presenting a more cost-effective option for health service providers. 


— Ethical Issues= Even though flooding is seen as an affordable option, it can be very distressing for patients and causes a lot of worry. While patients give their consent with full knowledge, a significant number don't finish their treatment due to the overwhelming stress involved. Consequently, flooding can be ineffective and a waste of time and money if patients don't complete their therapy. 



Part 7: Cognitive Approach to Explaining Depression 

Explanation 1: Beck’s Cognitive Triad 


Beck came up with an explanation for depression using three main parts: a) Faulty Information Processing; b) negative self-schemas; c) the negative triad. 


  1. a) Faulty Information Processing= Beck observed that people feeling depressed tend to focus more on the negatives of a situation, while overlooking the positives. They often twist and misinterpret information, a process called cognitive bias.

Beck listed various cognitive biases, including over-generalisations and catastrophising. For instance, a depressed person might make over-generalisations by drawing a broad conclusion from a single incident, like saying, ‘I failed one test, so I’ll fail ALL my exams!’ Alternatively, they may catastrophise, exaggerating a small setback and thinking it’s a complete disaster, such as, ‘I failed one test, so I'll never go to University or get a good job!’ 

  1. b) Negative self-schemas= A schema is a 'package' of knowledge that holds information about ourselves and the world. Beck suggested that depressed individuals develop negative self-schemas, often stemming from negative experiences like criticism from parents, peers, or teachers during childhood.

Someone with a negative self-schema tends to interpret information about themselves negatively, which can lead to cognitive biases, as mentioned earlier. 

  1. c) The negative triad= Beck proposed that cognitive biases and negative self-schemas contribute to the negative triad, an overall negative and irrational perspective of oneself, the future, and the world. For people with depression, these thoughts happen automatically and are characteristic of their condition.

The self – ‘nobody loves me.’ The world – ‘the world is an unfair place.’ The future – ‘I will always be a failure.’ 


Evaluation of Beck’s Cognitive Triad  (A03) 

+Real World Practical Applications= CBT, based on Beck's theory, focuses on challenging and changing the components of the negative triad. Identifying and challenging the elements of the negative triad is crucial in CBT, and this is a positive aspect because it demonstrates that the theory can be applied effectively in a treatment setting. 


— Limited Explanatory Power= Beck's theory does not cover all aspects of depression. Patients with depression often go through various emotions, ranging from anger to sadness, which Becks theory does not consider. Additionally, some individuals may experience hallucinations or hold unusual beliefs due to other conditions like Cotard Syndrome. As a result, Becks theory falls short in explaining all cases of depression, as it concentrates on only one aspect of the condition. 


Explanation 2: Ellis' ABC model 


Ellis offered a distinct perspective from Beck's cognitive triad in explaining depression, emphasising the role of rational and irrational thinking in mental health. According to Ellis, good mental health results from rational thinking, fostering happiness and freedom from pain. Conversely, depression stems from irrational thinking, hindering happiness and well-being. 

Ellis introduced the A-B-C three-stage model to elucidate how irrational thoughts contribute to depression: 

A: Activating Event 

An event occurs, such as a friend ignoring your greeting in the school corridor. 

B: Beliefs 

Your beliefs, the interpretation of the event, can be either rational or irrational. A rational interpretation might consider your friend's busyness or stress, while an irrational one may involve thinking your friend dislikes you. 

C: Consequences 

Ellis proposed that rational beliefs lead to positive emotional outcomes, like planning to talk to your friend later. On the other hand, irrational beliefs result in negative emotional outcomes, such as ignoring your friend and deleting their contact due to the assumption that they don't want to talk. 


Evaluation of Ellis' ABC model  (A03) 

+Real World Practical Applications= A notable strength of the cognitive explanation for depression lies in its practical application to therapy. Cognitive concepts have played a key role in the creation of successful depression treatments, such as Cognitive Behavioural Therapy (CBT) and Rational Emotive Behaviour Therapy (REBT), which originated from Ellis's ABC model. These therapeutic approaches aim to recognize and confront negative, irrational thoughts. They have proven effective in treating individuals with depression, offering additional endorsement to the cognitive explanation of depression. 


— Limited Explanatory Power= Much of the research in this domain relies on correlation, making it challenging to establish a causal relationship. Consequently, it remains uncertain whether negative, irrational thoughts cause depression or if a person's depression prompts a negative mindset. There is a possibility that other factors, such as genetics and neurotransmitters, serve as the root cause of depression, with negative, irrational thoughts emerging as one of the consequences of the condition. 


Part 8: Cognitive Approach to Treating Depression 

Cognitive Behavioural Therapy (CBT) combines cognitive and behavioural approaches to address depression. The cognitive aspect targets the identification and replacement of negative and irrational thoughts with positive ones. The behavioural component encourages patients to test their beliefs through experiments and homework. 

CBT comprises several components: 

  • Initial assessment 
  • Goal setting 
  • Identifying and challenging negative/irrational thoughts, using either Beck’s Cognitive Therapy or Ellis’s REBT 
  • Homework 


There are two strands of CBT based on Beck’s theory and Ellis’s ABC model. Both start with an initial assessment, followed by goal-setting and action planning. While both aim to identify negative and irrational thoughts, Beck’s Cognitive Therapy focuses on the negative triad, whereas Ellis’s REBT employs dispute to challenge irrational beliefs. 

Beck’s Cognitive Therapy involves discussing evidence for and against negative thoughts and encouraging patients to test their validity through homework. 

Ellis’s REBT uses the ABCDE model, disputing irrational beliefs through logical or empirical dispute. Homework assignments involve identifying and challenging irrational beliefs to facilitate belief change. For instance, someone anxious in social situations might be assigned the homework of meeting a friend for a drink to challenge and alter their beliefs. 


Evaluation of the Cognitive Approach to Treating Depression  (A03) 

+ Supporting Study= March et al. (2007) conducted research indicating that Cognitive Behavioural Therapy (CBT) is equally effective to antidepressants in treating depression. The study involved 327 adolescents diagnosed with depression, assessing the effectiveness of CBT, antidepressants, and a combination of both. After 36 weeks, 81% of the antidepressant group and 81% of the CBT group showed significant improvement, underscoring CBT's effectiveness. Notably, 86% of the combined CBT plus antidepressant group demonstrated significant improvement, suggesting that a combination of both treatments may be more effective in treating depression. 


—Appropriateness= An obstacle with Cognitive Behavioural Therapy (CBT) is its dependency on patient motivation. Individuals experiencing severe depression may struggle to engage with or attend CBT sessions, rendering this treatment ineffective for them. In contrast, alternative treatments like antidepressants don't demand the same level of motivation and may prove more effective in such cases. This presents a challenge for CBT, as it cannot serve as the sole treatment for severely depressed patients. 


Part 9: Biological Approach to Explaining OCD 

Explanation 1: Genetic Explanations: OCD 

Genetic explanations for Obsessive-Compulsive Disorder (OCD) propose that individuals inherit certain genes contributing to the development of OCD. Two identified genes associated with OCD are the COMT gene and SERT gene. The SERT gene, also known as the 5-HTT gene, influences serotonin transport and may lead to lower serotonin levels, a factor linked to OCD. The COMT gene plays a role in clearing dopamine from synapses, and low activity of the COMT gene is also linked to OCD. Additionally, OCD is considered a polygenic condition, implying that multiple genes play a role in its manifestation. 


Explanation 2: Neural explanations for OCD 


Neural explanations of Obsessive-Compulsive Disorder (OCD) focus on neurotransmitters and brain structures. 

These explanations propose that abnormal levels of neurotransmitters, specifically serotonin and dopamine, are connected to OCD. 

Concerning neurotransmitters, serotonin, which regulates mood, is believed to play a role in OCD. Lower serotonin levels, associated with mood disorders like depression, are also linked to some cases of OCD, potentially influenced by the SERT gene. Research on antidepressants supports the connection between serotonin and OCD, as drugs increasing serotonin levels prove effective in treating OCD patients. 

Additionally, dopamine, another neurotransmitter, has been implicated in OCD. Higher dopamine levels are associated with certain OCD symptoms, particularly the compulsive behaviours. 


Explanation 3: Brain Structures 

Two brain regions have been implicated in OCD, namely the basal ganglia and orbitofrontal cortex. 

The basal ganglia, a brain structure involved in various processes including movement coordination, has been linked to OCD. Patients recovering from head injuries in this region often exhibit symptoms resembling OCD. Additionally, Max et al. (1994) discovered that disconnecting the basal ganglia from the frontal cortex during surgery reduces OCD-like symptoms, offering additional support for the role of the basal ganglia in OCD. 

Another associated brain region is the orbitofrontal cortex, responsible for converting sensory information into thoughts and actions. PET scans reveal heightened activity in the orbitofrontal cortex in OCD patients. One theory suggests that increased activity in this region leads to intensified conversion of sensory information into compulsive actions. This heightened activity also hinders patients from stopping their compulsive behaviours. 


Evaluation of the Biological Approach to Explaining OCD  (A03) 

+ Supporting Study= Lewis (1936) investigated patients with OCD and discovered that 37% of those with the disorder had parents who also suffered from it, and 21% had affected siblings. Family studies, such as Lewis's, offer backing for a genetic explanation of OCD, although they do not dismiss the possibility of other environmental factors playing a role. 


—Reductionist= A drawback of the biological explanation for OCD is its failure to consider other factors and its reductionist nature. Specifically, the biological approach overlooks cognitions (thinking) and learning. Some psychologists argue that OCD may be acquired through classical conditioning and sustained through operant conditioning. In this context, a stimulus (such as dirt) becomes associated with anxiety through classical conditioning, and this connection is perpetuated through operant conditioning as the individual avoids the stimulus and engages in compulsive behaviors like hand washing. These actions reduce anxiety, negatively reinforcing the compulsions. 


Part 10: Biological Approach to Treating OCD 

Biological treatments for OCD aim to address imbalances, particularly low serotonin levels. Drug treatments, assuming chemical imbalances as the primary cause, use two types of drugs: (1) anti-depressants and (2) anti-anxiety drugs. 

Anti-depressant drugs: The biological explanation links OCD (and depression) to low serotonin levels. SSRIs (Selective Serotonin Re-uptake Inhibitors) are a type of anti-depressant, including drugs like Prozac. SSRIs increase serotonin levels in the synapse by preventing its reabsorption into the sending cell, leading to elevated serotonin levels received by the receiving cell. 

Anti-anxiety drugs: Benzodiazepines (BZs), such as Valium and Diazepam, belong to the anti-anxiety drug category. BZs enhance the neurotransmitter GABA, which signals neurons in the brain to slow down and stop firing. Since approximately 40% of neurons respond to GABA, BZs have a calming effect on the brain, reducing anxiety resulting from obsessive thoughts in individuals with OCD. 


Evaluation of the Biological Approach to Treating OCD  (A03) 

+Practical Applications (Practicality)= Biological treatments, such as anti-depressants and anti-anxiety drugs, are relatively cost-effective compared to psychological treatments like cognitive behavioural therapy (CBT). As a result, many doctors favour drug interventions due to their cost-effectiveness in treating OCD (and depression), providing benefits for health service providers. 


—Appropriateness= A weakness of drug treatments for OCD is the potential side effects of medications like SSRIs and BZs. While evidence supports the effectiveness of SSRIs in treating OCD, some patients may encounter mild side effects such as indigestion, while others may experience more severe issues like hallucinations, erection problems, and elevated blood pressure. BZs are known for their high addictive potential and can induce increased aggression and long-term memory impairments, leading to their limited prescription for short-term treatment. These side effects can diminish the overall effectiveness of drug treatments, as patients often discontinue medication if they experience such adverse reactions. 

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