AQA A-LEVEL PSYCHOLOGY REVISION NOTES: PSYCHOPATHOLOGY

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PSYCHOLOGY AQA A-LEVEL UNIT 1: 7182/1

THE SYLLABUS

CHARACTERISTICS OF DISORDERS

The behavioural, emotional and cognitive characteristics of phobias, depression and obsessive-compulsive disorder (OCD)

PHOBIAS – BEHAVIOURAL EXPLANATION & TREATMENT

The behavioural approach to explaining and treating phobias: the two-process model, including classical and operant conditioning; systematic desensitisation, including relaxation and use of hierarchy; flooding

DEPRESSION – COGNITIVE EXPLANATION & TREATMENT

The cognitive approach to explaining and treating depression: Beck’s negative triad and Ellis’s ABC model; cognitive behaviour therapy (CBT), including challenging irrational thoughts

OBSESSIVE-COMPULSIVE DISORDER (OCD) – BIOLOGICAL EXPLANATION & TREATMENT

The biological approach to explaining and treating OCD: genetic and neural explanations; drug therapy

DEFINITIONS OF ABNORMALITY

Definitions of abnormality, including deviation from social norms, failure to function adequately, statistical infrequency and deviation from ideal mental health

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INTRODUCTION

Psychopathology is a broad-ranging field of study concerned not only with the likely causes of and effectiveness of treatments for mental disorders but with more philosophical questions concerning how and why we define others as psychological abnormal and how those labelled as psychologically abnormal are treated by society.

The syllabus covers 3 disorders: phobias, depression and obsessive-compulsive disorder (OCD). Each disorder is examined from the perspective of 1 psychological approach in terms of how the disorder is caused and how it can best be treated – Learning Theory for phobias, the Cognitive approach for depression, and the Biological approach for OCD.

Pre-scientific (pre-18^th C.) explanations of abnormality tended to view madness as a spiritual/religious problem (e.g. demonic possession and exorcism).

With the rise of science ‘madness’ began to be viewed as a biologically caused ‘mental illness’ treatable through medical means. The biological approach argues that some individuals may be genetically predisposed to experience imbalances in neurotransmitter levels and/or neural (brain) abnormalities which produce the symptoms of disorders. Treatment centres around psychiatric drugs which aim to rebalance these imbalances.

Behavioural Learning theory argues that certain disorders (e.g. phobias) could be regarded as maladaptive behaviours which have ‘learnt’ through the mechanisms of classical and operant conditioning and can be unlearnt in the same manner.

The Cognitive approach argues that disorders such as depression arise from maladaptive ways of thinking (cognitions) and that these negative, irrational cognitions affect our emotions and behaviour. Cognitive-behavioural therapy (CBT) aims to promote more positive and rational ways of thinking.

There are, of course, many hundreds of mental disorders and other approaches which aim to explain and treat them. For example, the psychodynamic and humanistic approaches (covered in the Approaches in Psychology topic in Paper 2) often focus on the role of early childhood experiences.

Despite several centuries of research there is little agreement on the precise causes of mental disorders or how best to treat them.

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THE BEHAVIOURAL, EMOTIONAL AND COGNITIVE CHARACTERISTICS OF PHOBIAS, DEPRESSION AND OBSESSIVE-COMPULSIVE DISORDER (OCD) (AQA A-level Psychology notes)

CHARACTERISTICS OF PHOBIAS

Specific (simple) phobias are a fear of objects (e.g. arachnophobia - spiders) or situations (e.g. aerophobia -planes).

Social Phobia is a fear of social situations.

Approx. 2.6% of the population suffers phobias.

Emotional characteristics: an extreme, excessive, irrational fear of the phobic object/situation.

Behavioural Characteristics: avoidance of the phobic object/situation; stress response (arousal of the autonomic nervous system and fight/flight response, or ‘freezing’ in fear.

Cognitive Characteristics: irrational thoughts or fear out of proportion to the real danger posed by the object/situation.

CHARACTERISTICS OF DEPRESSION

Depression involve the sufferer experiencing either permanently or periodically low mood.

Approx. 2.6% of the population suffers depression.

Emotional characteristics: sadness, low motivation, loss of interest in normal activities, hopelessness.

Behavioural Characteristics: poor self-care, loss of appetite/sex drive, social withdrawal, lack of energy, insomnia, suicide.

Cognitive Characteristics: low self-esteem, poor concentration, guilt, negative thoughts.

CHARACTERISTICS OF OBSESSIVE-COMPULSIVE DISORDER (OCD)

OCD involves experiencing persistent, intrusive, irrational thoughts (obsessions) which compel (force) the sufferer to compulsively perform repetitive behaviours.

Approx. 1.3% of the population suffers OCD.

Emotional characteristics: emotional distress and anxiety, embarrassment and shame; an obsession with germs which leads to the emotion of disgust.

Behavioural Characteristics: compulsive behaviours are performed to reduce the anxiety produced by obsessive thoughts: for example, repetitive cleaning and tidying behaviours to reduce the anxiety caused by fear of germs and infection.

Cognitive Characteristics: recurrent, intrusive, irrational thoughts often centred on germs/cleanliness/orderliness, doubts/anxieties (e.g. that something important has been overlooked), impulses (e.g. shouting out obscenities).

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THE BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS (A-level Psychology revision notes)

THE TWO-PROCESS MODEL, INCLUDING CLASSICAL AND OPERANT CONDITIONING

Behaviourists argue that all behaviours are learnt through interaction with events in the environment. The behaviours which characterise the symptoms of mental disorders are acquired in the same way as any other behaviour (CC, OC and SLT). Behaviours typical of phobias are avoidance behaviour (external behaviour) and feelings of fear (internal behaviour).
The 2-process model argues that phobias are learnt through classical and operant conditioning:

Classical Conditioning (CC): behaviours are acquired through ‘stimulus-response’ associations: e.g. an event in the environment (stimulus) will cause a physiological effect (response) such as fear. For example, repeated negative experiences with dogs (being bitten) may lead to a phobic response.

Watson’s (20) classical conditioned a phobia of a white rat in an 11-month old boy named Little Albert. At the beginning of the study he showed no fear of white fluffy objects such as cotton wool, a white rat and a white rabbit (these were neutral stimuli). Watson presented the white rat to Albert whilst scaring him by banging metal bars together to create a frightening noise. This was done 3 times then repeated a week later. From then on, whenever Albert was shown the white rat (without the noise) he began to cry. He generalised this fear to other similar white, fluffy objects. Thus, Watson claimed phobias were classically conditioned through negative stimulus-response associations between objects (the stimulus) and fear (the response).

Operant Conditioning (OC): the phobia is maintained through OC. When a behaviour is reinforced (rewarded) it is more likely to be repeated. Avoidance of phobic objects is rewarding because we avoid the fear we believe they will cause. This is an example of negative reinforcement – being rewarded for escaping an unpleasant situation. For example, the behaviour of not taking a life to avoid claustrophobia strengths the behaviour of not taking lifts as one avoids the anxiety that would occur if one did take the lift.

Social Learning Theory (SLT) would also emphasise how fears can be learnt from parents via observation and imitation. An infant may either:
- simply imitate a behaviour: e.g. one’s mother’s phobic behaviour (modelling) or,
- imitate a behaviour because they expect a reward (vicarious learning): g. seeing one’s mother being given care after a phobic response so imitating her hoping to receive the same reward.

EVALUATION

Fears may be evolutionarily determined and genetically inherited to help us avoid and escape potentially dangerous situations and animals. This seems clear from the fact that the most common phobias – snakes, spiders, rats, heights, darkness, etc. are potentially dangerous. Seligman used the concept of ‘biological preparedness’ when examining phobias. He found that rats could be easily conditioned to avoid life-threatening stimuli such as toxic liquids or electric shocks, but could not be easily conditioned to avoid non-harmful stimuli such as flashing lights. This provides evidence against Behavioural explanations in that it seems to suggest that phobias are innate, not learnt, and it explains why particular types of phobia are more common.
Many people have bad experiences with stimuli but do not go on to develop a phobia, and many people develop a phobia despite having no previously negative experiences with their phobic object. Behavioural explanations argue that we develop phobias of objects we have frightening experiences with: for example, in the modern world, cars, guns or electricity. However, phobias of these stimuli are extremely rare and despite the fact that most people rarely encounter snakes, this phobia is very common.
Behavioural explanations ignore the role of biological factors (e.g. genetic predisposition) and cognitions (e.g. how we think) in the onset and treatment of phobias. Some studies do show a predisposition to developing phobias is genetically inherited, and some studies indicate that cognitive therapies may be effective in treating phobias.

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THE BEHAVIOURAL APPROACH TO TREATING PHOBIAS (AQA A-level Psychology revision notes)

SYSTEMATIC DESENSITISATION, INCLUDING RELAXATION AND USE OF HIERARCHY; FLOODING

SYSTEMATIC DESENSITISATION (SD)

SD was developed by Wolpe in the 50’s to treat phobias – both simple (objects: e.g. arachnophobia) and social (e.g. agoraphobia). Behaviourism assumes that phobias are learnt through the process of classical conditioning: i.e. a negative stimulus-response association has been formed between the phobic object and fear. SD aims to ‘unlearn’ this negative, fear-based response and replace the response of fear with relaxation.

A Behavioural therapist will gradually expose their client to the feared object or situation.

The client and therapist draw up an ‘anxiety hierarchy’ of situations that cause anxiety, from minor discomfort to major suffering.
The therapist induces a state of deep relaxation in the client using progressive muscle relaxation, hypnosis or tranquillisers. A state of relaxation is incompatible with anxiety.
In this relaxed state, the client is repeatedly exposed to the 1^st step on the anxiety hierarchy until feelings of anxiety are replaced by relaxation.
The client gradually progresses upward through the stages of the anxiety hierarchy until their most feared situations is paired with relaxation rather than anxiety.
If at any time they start to feel anxious they are taken down a step on the hierarchy.
SD can either be in vivo (exposure to real life feared stimuli) or in vitro (imagining feared stimuli).

EVALUATION

STRENGTHS

Research has indicated SD is an effective treatment for phobias. McGrath (’90) reported that 75% of patients with phobias responded to SD, and Capafons (’98) reported that aerophobics who had undergone SD reported lower levels of fear and showed lower levels of physiological arousal compared to a control group when subjected to a flight simulation.

Behavioural therapies are quick and require less effort on the patient’s behalf than psychotherapies where patients must play a more active part in their treatment. As a result, successful outcomes can be achieved fairly quickly. As SD does not require the intellectual engagement required with talking therapies SD may be the only appropriate form of treatment for those of lower general intelligence.

WEAKNESSES

SD has been successful in treating simple phobias, however, treatment may not provide a long-lasting solution. This may be because the symptoms of the phobia (anxiety) are just the external signs of a much deeper-rooted problem. If SD manages to remove the symptoms of a phobia, a new set of symptoms may arise: this is referred to as symptom substitution. Because Behaviourism assumes that phobias are learned, SD makes no attempt to address any deeper psychological or emotional causes of the disorder.

Ohman (’75) suggests that SD may not be effective for treating anxieties which have evolutionary origins (e.g. fear of the dark, fear of dangerous animals, etc.) The logic behind this alternative explanation of phobias is that phobias are exaggerated anxieties of stimuli which posed survival threats to our ancestors which have become genetically hard-wired into behaviour. Thus, these types of phobias have a different cause and are harder to unlearn.

FLOODING

An alternative to gradual exposure to the phobic object is immediate and full exposure – e.g. a claustrophobic being forced to be in an enclosed space for a long period of time. The logic behind flooding is that as time goes on adrenaline levels will decrease, panic will eventually subside and the individual will form a new stimulus-response association between the phobic object and relaxation. Flooding can either be in vivo (real life) or in vitro (using imagination).

Flooding can be highly traumatic and is therefore likely to be unethical (failure to protect subjects from psychological harm). Given this fact it is rarely carried out.

On the other hand, a study by Choy (07) reported that flooding was more successful than SD when treating phobias.

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THE COGNITIVE APPROACH TO EXPLAINING DEPRESSION: BECK’S NEGATIVE TRIAD AND ELLIS’S ABC MODEL (Psychology A-level revision)

The Cognitive Model was founded by Ellis and Beck in the 60’s who argued that Behaviourism’s main weakness was its failure to take human thought processes into account when explaining behaviour.

The Cognitive Model argues that psychological and emotional disturbance can often be attributed to maladaptive cognitions: e.g. irrational, illogical, negative, distorted patterns of thinking about oneself, others and the world. For example, a depressive may automatically think about themselves and their life in entirely negative (and unrealistic) terms.

ELLIS’ ABC MODEL

The ABC Model argues that it is our cognitions which affect our emotional responses: e.g. a depressive’s irrational beliefs lead to sadness, anxiety and low self-esteem, which in turn will lead to behaviours such as unsociability, low motivation, etc. These behaviours will reinforce negative cognitions leading to a downward spiral of thought, emotion and behaviour.

AQA PSYCHOLOGY A LEVEL PSYCHOPATHOLOGY COGNITIVE APPROACH

A – refers to an activating event (e.g. failing an exam)

B – refers to a rational (I failed because I didn’t work hard enough) or irrational (I failed because I’m not clever enough) belief

C – refers to the emotion which result from the belief – either healthy (I will try again) or unhealthy (I will give up)

BECK’S NEGATIVE TRIAD

People may acquire negative schemas during childhood – adopting a negative view of (i) themselves, (ii) the world and (iii) the future. This may be caused by parental or peer rejection/criticism.

Such thinking leads depressives to have a distorted, limited outlook on life and de-motivates them from engaging in activities which might reduce their depression. Depressives also display a distinctive pattern of selective attention whereby they pay excessive amounts of attention to the negative aspects of events and minimal amounts to positive aspects of events.

AQA A LEVEL PSYCHOLOGY PSYCHOPATHOLOGY COGNITIVE TRIAD

Negative schemas lead to a negative triad of cognitive biases about

The self: ‘I am undesirable, uninteresting, etc.’
The world (life experiences): ‘I’m not surprised people don’t like me’.
The future: ‘There is nothing I can do to change – things will always be this way’.

EVALUATION

WEAKNESSES

The Cognitive model suggests that it is the patient’s faulty thinking which is responsible for their disorder: e.g. they are depressed as a result of engaging in irrational, negative thinking. This may lead one to overlook the role of biological or environmental factors in causing mental disorders: e.g. a biochemical imbalance, family problems, abuse, etc. For example, the biological approach would argue that it is biochemical imbalances (low levels of serotonin) which cause negative thinking and negative thinking would improve by altering the body’s biochemistry (e.g. prescribing anti-depressants). Thus, the cognitive model’s cause-effect beliefs may be incorrect.
The Cognitive model argues that depressives’ cognitions are irrational. It could well be argued that if someone has experienced a lot of negative life events (e.g. lost their job, their partner, etc.) these cognitions are quite rational and realistic.

STRENGTHS

The Cognitive Model focuses on neurotic disorders such as depression, anxiety and eating disorders, but is also widely employed within the NHS to treat stress and ‘life problems’, and within the prison service with sexual offenders and those with anger management issues. Therapies based on the Cognitive approach are popular as they are fairly quick, cheap, easy to understand, and seem to have a fairly good success rate.
The Cognitive Model addresses the important role that thought processes have in effecting emotional and behavioural responses in a wide range of mental disorders. Cognitive therapies are popular and place the client in a central, active role in helping overcome their own problems - thus these forms of therapy are seen as ‘empowering’.

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THE COGNITIVE APPROACH TO TREATING DEPRESSION (A-level Psychology revision)

COGNITIVE BEHAVIOUR THERAPY (CBT)

As the Cognitive Approach assumes that negative, irrational thinking influences emotions and behaviour, CBT is based on the assumption that if we alter cognitions this will result in positive change to patients’ emotions and behaviour.

In CBT the therapist attempts to challenge and expose the client’s automatically negative, irrational thinking and encourage more positive and rational cognitions regarding how they view themselves, the world and their future.

CBT particularly focuses on testing and attempting to disprove clients’ negative cognitions and encouraging clients to carry out practical activities and tasks. For example; if a depressive stated that there was no point in them going out for the evening with friends because they wouldn’t enjoy it, the therapist would:

Ask the client to examine which cognitions underlay this set of beliefs.
Expose these cognitions as being automatically negative and maladaptive, and encourage more adaptive, positive thinking.
Set the client the task of going out with friends for the evening.
Get the client to record their thoughts and behaviour during the evening to test whether positive thinking did lead to more positive emotions and behaviour.

Hopefully, engaging in activities such as this will lead to rewarding experiences which reinforce behaviours and make it more likely the client will repeat them: i.e. going out with friends will be pleasurable so it’s more likely the client will do it again. This will lead to a positive cycle of reinforcement which should decrease depression.

Commonly employed ways of challenging negative thinking include

Logical disputing – explaining to the client how their self-defeating beliefs are irrational/illogical (e.g. their way of thinking does not make sense).
Empirical disputing – a client’s self-defeating beliefs are not backed up by evidence (e.g. there is no proof that a particular belief is accurate).
Pragmatic disputing – emphasise to the client how unhelpful negative thinking is (e.g. this way of thinking is not going to help me).

EVALUATION

STRENGTHS

CBT has been proven effective in outcome studies which measure responses to treatment. Engels (’93) conducted a meta-analysis of 28 studies and concluded that REBT (Rational Emotive Behavioural Therapy – a form of CBT) was an effective treatment for depression.

Ellis claimed that over an average of 27 sessions, REBT had a success rate of 90%, although an important variable in success was the client’s own effort in putting new beliefs into action.

CBT can be delivered via computer. Christensen (’04) examined the effectiveness of MoodGYM – an online form of CBT for depression. The program contains anxiety and depression assessments, relaxation techniques and tasks to complete. Participants were assigned to MoodGYM, another depression information website or a placebo group. MoodGYM was found to be as effective as face-to-face therapy and drug treatments for depression. It was also the most cost-effective treatment and overcomes therapist subjectivity and potential client embarrassment.

WEAKNESSES

CBT fails to address the root cause of outside factors which may be producing irrational thinking in the 1^st place either in the present: e.g. marriages with bullying partners, or in the past: e.g. a history of childhood neglect. As a result, outside environments or past events may continue to contribute to the likelihood of irrational thinking continuing. REBT also fails to consider that what appears to be irrational thinking: e.g. depression and a sense of helplessness, may in fact be a logical response to life events: e.g. unemployment, poverty, loneliness.
CBT takes time and effort on the depressive’s behalf. Considering severe depressives may not have the motivation to engage in CBT, antidepressants may be more suitable for extreme cases where the client requires quick treatment (e.g. they are suicidal) or do not have the motivation to engage with therapy.

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THE BIOLOGICAL APPROACH TO EXPLAINING OCD: GENETIC AND NEURAL EXPLANATIONS (AQA A-level Psychology) revision

GENES

Biological approaches argue that many mental disorders are genetically inherited and the cause of the disorder may lie in genetic abnormalities which cause changes in brain structure and/or abnormal levels of neurotransmitters....

For full syllabus notes and model answers to all past paper questions please click here