Look at that! We’ve almost finished our detailed overview of all the topics in Paper One. Give yourself a pat on the back! And me, please give me a pat on the back, too.
So, Psychopathology, as we’ve already covered, is a fancy word for mental illness. That means that in this topic, we learn how to define mental illness, and then we learn the characteristics of Phobias, Depression and OCD, then how to explain and treat them! And then we’re done, sort of. Without further ado, here’s our bullet-point list of everything in Psychopathology.
- Definitions of Abnormality
- Phobias; Depression; Obsessive-Compulsive Disorder
- Behavioural Approach to Explaining and Treating Phobias
- Cognitive Approach to Explaining and Treating Depression
- Biological Approach to Explaining and Treating OCD
That’s all of it – onward we go!
Definitions of Abnormality
Before we move on to explaining and treating the three core mental illnesses in this topic, we need to discuss exactly how mental illness is defined. As it turns out, there are four different definitions of abnormality.
The first one is Statistical Infrequency. That one is pretty simple to figure out. You should have gone over measures of central tendency in GCSE Maths, and measures of central tendency are a good place to start here. See, from your mean average, which should usually be the very middle of the population, you get a spread of different statistics around this mean score. Usually, an ‘abnormal’ measure is something that is two standard deviations away from the mean.
For example, the most common age for a woman to have a baby is around 30 years old in the UK, and a standard deviation from this point is five years. This makes having a baby before the age of 20 or after the age of 40 abnormal.
We can define mental illness like this, too.
The next definition of abnormality is Deviation from Social Norms, which is not a maths-based concept. It’s quite simple, really: showing up to school in a wetsuit unprompted is a deviation from the social norm and is not considered an acceptable behaviour. Standing in the middle of London Victoria and screaming is a deviation from social norms. Not shaking the president’s hand is a deviation from social norms. Some of these rules are unspoken, whilst some are enforced by law.
After this, we have Failure to Function Adequately. This is when someone is unable to go about their day-to-day life in an effective way, such that it causes them or the people around them to become distressed. This means things like not eating or not doing the laundry. It is important to note that this must cause the individual or their peers some distress, as some people are quite content with their living conditions and in these cases a label of abnormality is not considered appropriate.
Finally, we have Deviation from Ideal Mental Health. This one is pretty widely criticised because of the parameters it lays out for ideal mental health being unrealistic. It’s based on the fact that according to Jahoda, we diagnose physical illness by looking for an absence of certain signs, which also applies to her theories about mental health. She claims that an entirely mentally healthy individual will high self-esteem, self-actualisation, integration and an ability to deal with stress, independence, an accurate perception of reality, and a mastery of the environment.
Phobias, Depression, Obsessive-Compulsive Disorder.
The disorders studied in this topic are defined under three different categories of behaviour and distress: cognitive, behavioural, and emotional.
Phobias are defined as an intense fear and avoidance of a specific object or situation. You might be familiar with arachnophobia, or the fear of spiders. The emotional characteristics of phobias are persistent and excessive feelings of fear, anxiety and panic cued by the presence of a specific object or situation. The key behavioural characteristic of Phobia is avoidance of the feared object or situation, with involuntary bodily responses such as the freeze-or-faint response occurring. The Avoidance will interfere significantly with the individual’s day-to-day life. The main cognitive characteristic of Phobia is irrational thought and a resistance to rational thought, however it should be noted that most individuals with phobias are usually aware that their thoughts are irrational, and this is the distinguishing factor between Phobia and disorders with an element of psychosis.
Depression is a mood disorder, with varying characteristics. For Depression to be diagnosed, an individual’s emotional characteristics must comprise of at least five symptoms, and these must include sadness or loss of interest in previously-enjoyed activities. Anger may also factor into this. Behavioural characteristics can be observed as the depressed patient having an increased or decreased activity level, amount of sleep, and appetite. Finally, the main cognitive characteristic of Depression is a negative view of the world, the self, and the future – and this is often irrational.
OCD is another anxiety disorder, with the key emotional characteristics being severe anxiety, with guilt and embarrassment also occurring frequently. The key cognitive characteristic in OCD is obsessions, which are often very intrusive and upsetting thoughts which cause anxiety. As with Phobia, it should be noted that individuals with OCD are able to recognise that these thoughts come from their own mind, rather than being inserted in some way, which differentiates it from psychotic disorders. The main behavioural characteristic of OCD is compulsions, which are often performed to try to ease the distress of obsessions, though there may not be any perceivable link between the action and the thought.
The Behavioural Approach to Explaining and Treating Phobias
We talked about Learning Theory when we covered Attachment, and Learning Theory comes into play again here, so try to keep in mind the general concept of reinforcement that lies behind Learning Theory.
The main way of explaining Phobias is through something called the Two-Process Model, which explains how a Phobia is formed, and then how a Phobia is reinforced. The first step is called initiation, and focuses on the formation of the Phobia. It happens through a process called Classical Conditioning, which we didn’t really cover in Attachment, so try to keep an eye on this one.
Let’s say you have a Phobia of balloons. I use balloons because I have a lot of friends who really hate them. A lot of the time, the aversion to balloons doesn’t come from the balloon itself, but from either the loud noise they make when they pop or the horrible squeaky noise they make when you rub against them. (If, by some miracle, you’re using this in class, and if there are balloons in your classroom, do not pop them or rub against them just to distress a classmate. Also, if you have a classmate with particularly fine hair, don’t rub it against their head. Getting rid of the frizz is an ordeal – trust me.) This is called association. The Unconditioned Stimulus is the noise, and the Unconditioned Response is anxiety (the fight-or-flight-or-freeze response). The balloon is a Neutral Stimulus, but the association with noise turns it into a Conditioned Stimulus, and an individual has the Conditioned Response of anxiety.
That part is how the Phobia is initiated. The next bit is how the phobia is maintained.
The phobia is maintained through a process called Operant Conditioning – and this is what we covered in Learning Theory, if you remember, which I hope you do. It’s based on reward – that part is very important. The reward in this case is avoiding the discomfort associated with the noise. This is called negative reinforcement, as the reward is the loss, rather than the gain, of something. This makes the behaviour more likely in the future.
That’s how the phobia is maintained. When we cover this in more depth, I’ll tell you about some weird insect stuff – it’s pretty dope.
Now, we move onto how to treat phobias. This can be done in a couple of ways – through something called Systematic Desensitisation, or through Flooding. We’ll start with Systematic Desensitisation, because Flooding is… kind of (very) mean.
Systematic Desensitisation and Flooding follow the same general concepts. The first step is always to start with learning relaxation techniques, though, because the anxiety response always involves a release of adrenaline and several bodily processes. For all my pals who have panic attacks, you might be familiar with these as the breathing exercises your friends and family go through with you to stop you hyperventilating and make your chest hurt a little less. This works because the patient begins to associate the stimulus with relaxation, not fear. This is called counterconditioning (this is also called why revising is great, because I did not know that 30 seconds ago, and the exam is in nine days, which is absolutely fine and absolutely does not make me feel faintly nauseous.)
Your warning before scrolling down is that if you’re using the textbook, it’s a good idea to be mindful that in this block, there is a large and slightly gross photo of a tarantula. I will not be replicating this image.
The process of Systematic Desensitisation works through a hierarchy of five steps. We’ve been through the first step, which is relaxation. The next step is having the individual construct the desensitisation hierarchy with their therapist – they’ll go through what’ll cause them a little bit of distress right through to something that causes them a lot of distress. They’ll take the hierarchy stage-by-stage, going through each step one at a time. Once they have mastered one step, they can move onto the next. Eventually, they will have mastered the entire hierarchy.
Flooding has only two steps. The first one is relaxation again. The next one is – well – flooding. The individual is exposed to their phobia outright, through one long desensitisation session in which they practice the relaxation techniques. This is thought to work because adrenaline can only last out in the body for so long before it is no longer produced, at which point the association can begin to occur.
Cognitive Approach to Explaining and Treating Depression
We haven’t learnt the cognitive approach yet. Or, we might have – I have, because my A Levels start in nine days – but if you’re using this to learn Psychology, you probably haven’t. Either way, let’s briefly run over the Cognitive Approach. The Cognitive Approach focuses on thoughts and why people think like they do. In Memory, we discussed that Input > Process > Output model, and the Cognitive Approach Focuses on the Process part of that.
The Cognitive Approach to Explaining Depression asserts that Depression is caused by negative and irrational thought processes. It is explained through Ellis’s ABC model, and through Beck’s Negative Triad. I’m going to start with the ABC model, because it’s stuck to the wall right in front of me, which means I don’t need to faff about with finding information. (Occam’s Razor works here, even if it doesn’t in Learning Theory of Attachment.)
So, the ABC Model. ABC stands for Activation, Belief, Consequence. In all circumstances, there is an Activating Event. My form tutor’s voice is reminding me that now is not an appropriate time to cover the philosophy behind that, and – oddly – I think I can hear Aaron Burr saying it as well. But, yes, there is always an Activating Event. Let’s use being fired as an example. This then leads to a belief, and here’s where it varies a bit. The belief can be either Rational or Irrational. A rational belief might be something like: “the company was going bankrupt and had to make sacrifices – I’ll find a new job”. An irrational belief could be: “I will never, ever find another job”. As with anything, there is a Consequence to this. The consequence of a rational thought tends to be a healthy emotion, whereas with the irrational thought it will be an unhealthy emotion. The unhealthy emotion can then lead to depression.
Beck’s negative triad is equally simple. It asserts that in the development of Depression, an individual has three irrational negative views: a negative view of the self, a negative view of the world, and a negative view of the future. These all feed into each other and directly worsen each other. For example, a negative view of the self might be “I’m stupid”, which could lead to a negative view of the future being “I’ll never get a job” and a negative view of the world being “everyone is more successful than me” – do you see how the points of the triad all have an effect on each other?
That’s a rhetorical question, and the answer is yes, you do. Or you don’t – in which case, leave a comment, and I’ll see what I can do to help.
Now, onto treatment. The main cognitive treatment for depression is called Cognitive Behavioural Therapy. Try to store this one, as it’s pertinent information for when we study Schizophrenia, unless you aren’t studying Schizophrenia. Cognitive Behavioural Therapy is centred around correcting irrational thoughts, and it is something called a talking therapy.
If you don’t like the sound of CBT, but you’re struggling a little bit, I’m going to urge you to see your GP here anyway. We don’t cover them in Psychology, but there are other talking therapies which might suit your needs better.
Back onto CBT. Firstly, Ellis called his therapy RET, or Resolving Emotions Therapy, because that’s what he was focusing on, but that’s not massively important.
Ellis also extended the ABC model to the ABCDEF model, with DEF focusing on how to treat it. That’s simple, but also kind of inane – how long do you think it took him to extend out that acronym into something workable? I want to say a lot.
D means Disputing, which means disputing the irrational thoughts. There are a few kinds of disputing. These are called logical disputing, empirical disputing, and pragmatic disputing. Logical disputing follows an ‘is this realistic’ thought pattern, empirical disputing is ‘is there evidence for this’, and pragmatic disputing is ‘is this helpful to me’.
The E is Effective Disputing and Effective Attitude to Life – so everything is basically just super effective. The F is for the new Feelings after therapy. See what I mean about it being sort of inane? You still need to know it though, so – deal, I guess.
Individuals undergoing CBT are also often given homework to do between sessions, such as keeping a mood diary or log. It is also supposed to focus of Behavioural Activation, or encouraging individuals to engage in activities that they haven’t engaged in, which plays on the common idea that enjoyable activities are an antidote to Depression. The therapist should also offer the individual Unconditional Positive Regard, in order to convince the individual of their value as a human being and reduce feelings of worthlessness.
Biological Approach to Explaining and Treating OCD
Advance Warning: This bit’s the science bit – sorry. I don’t really like it either.
I’m assuming you kind of already know what the biological approach entails – it’s body stuff. So, in explaining OCD, you have genetic explanations and you have neural explanations. Genetic explanations refer to the stuff that gets passed down to you from your parents, whilst neural explanations refer to stuff that goes wrong in the brain itself.
There are two main genes in the genetic explanation, and then something called the diathesis-stress model. The first gene here is called the COMT gene, which regulates dopamine. Having too much Dopamine is implicated in OCD. One form of the COMT gene is more frequent in people with OCD, and this form produces lower COMT activity and higher levels of Dopamine.
The next gene is called the SERT gene, which affects serotonin transmission. The variation of the SERT gene found in OCD is associated with lower levels of serotonin, another neurotransmitter.
The final part, the diathesis-stress model, is important to remember because, like CBT, it comes up in Schizophrenia. It’s based on the idea that the gene may exist, but the disorder has to be activated by a stressor in the environment. Someone with a dramatic variation on the COMT or SERT gene might only require a slight stressor to develop the disorder, whereas someone with a slight variation of the gene would require a more drastic stressor.
Now, we move onto neural explanations. This is pretty fun revision for me, because I can’t remember a thing about these off the top of my head.
Neural explanations have two components to them: abnormal levels of neurotransmitters, and abnormal circuits in the brain.
We’ve already touched on abnormal levels of neurotransmitters. High levels of dopamine are implicated in OCD, as suggested by animal studies which show that doses of dopamine cause the compulsive moments associate with OCD. In contrast, low levels of serotonin are implicated in OCD, based on the fact that antidepressants which increase serotonin have been shown to have a positive effect on OCD, whilst those that don’t do not.
Brain circuits. I hate this part. There’s so much stuff and far too many words. I’ll try and keep it simple. The three important parts of the brain here are the Caudate Nucleus, the Orbitofrontal Cortex, and the Thalamus. In OCD, the Caudate Nucleus does not suppress messages from the Orbitofrontal Cortex. This means that the Orbitofrontal Cortex doesn’t filter out the stimuli which aren’t worrying when sending worry messages to the Thalamus. This is called a worry circuit.
Neurotransmitters are implicated here, too, because serotonin is integral in the function of the Caudate Nucleus and the Orbitofrontal Cortex, and dopamine is important in the part of the brain these are located in (the Basal Ganglia)
Now onto treatments. This is biological, so they’re mostly drug treatments, because lobotomies are considered outdated and unethical.
The first and most common drug treatment is the use of SSRIs. Unfortunately, you need a bit of biology to know how these work, so here: when an impulse reaches the end of a nerve, it has to move across a synapse to the next nerve. Sometimes the neurotransmitte gets reabsorbed. SSRIs focus on serotonin, and they try to stop this from happening by making the next nerve more receptive to serotonin, by inhibiting the re-absorption from the last nerve.
If SSRIs don’t work, an individual might be prescribed tricyclic antidepressants, which also implicate the action of a neurotransmitter called noradrenaline. These work in the same way as SSRIs, by blocking re-absorption from the pre-synaptic neuron, but it affects two neurotransmitters. However, it also causes more serious side-effects.
Benzodiazepines, which are anti-anxiety medication, might also be used. These slow down activity in the Central Nervous System and encourage the activity of a relaxant neurotransmitter called GABA. This makes it harder for other neurotransmitters to stimulate the neuron, which relaxes the individual.
And – whew – would you look at that! We’ve whizzed through all of Paper One now, so I’m going to jump onto Social Influence again, topic by topic. Get your evaluation brains out, pals, because we’re going to be evaluating.
Or, I’m essentially going to be writing short essays, because copying the textbook is kind of boring.