Anxiety Disorders and Depression: Emotional, Behavioral, and Cognitive Characteristics, Study notes of Psychology

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AS PSYCHOLOGY REVISION

PSYCHOPATHOLOGY

3.2.2 Psychopathology Specification

• Definitions of abnormality, including deviation from social

norms, failure to function adequately, statistical infrequency

and deviation from ideal mental health.

• The behavioural, emotional and cognitive characteristics of

phobias, depression and obsessive compulsive disorder (OCD).

• 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.

• 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.

• The biological approach to explaining and treating OCD: genetic

and neural explanations; drug therapy.

DEFINITIONS OF ABNORMALITY

DEVIATION FROM SOCIAL NORMS

• Abnormal behaviour is

seen as a deviation from unstated rules about how one “ought” to behave

• Anything that violates

these rules is considered

abnormal

• These rules are set by

society

• E.g. politeness

EVALUATION OF DfSN

• Susceptible to abuse
  • This varies in time (e.g. 50 years ago it was socially unacceptable to be homosexual; now it is acceptable)
  • Szasz (1974) claimed that the concept of mental illness was simply a way to exclude nonconformists from society
• Deviance is related to context and degree - Making judgement on deviance is related to the context of behaviour - There is a fine line between abnormal deviant and harmless eccentricity
• There are some strengths
  • DfSN does distinguish between desirable and undesirable behaviour
  • DfSN also takes into account the effect that behaviour has on others
  • DfSN says that abnormal behaviour is one that damages others

DEFINITIONS OF ABNORMALITY

FAILURE TO FUNCTION

ADEQUATELY

• People are judged on their

ability to go about daily life

• E.g. eating regularly, washing clothes, being able to communicate with others, etc
• If they cannot do this and

are also experiencing

distress (or others

distressed by their

behaviour) then it is

considered a sign of

abnormality

EVALUATION OF FtFA

• Who judges?
  • A patient may recognise that their behaviour is undesirable and become distressed
  • Or they may be content in their situation but others are uncomfortable and judge them to be abnormal
  • The weakness of FtFA is that it depends on who is making the judgement on abnormality
• The behaviour may be quite functional
  • Some dysfunctional behaviour may actually be functional (e.g. cross-dressing is regarded as abnormal but people make money out of it)
• Strengths of this definition
  • FtFA does recognise the subjective experience of the patient (allowing us to see the point of view of the person experiencing it)
  • Failure to Function is quite easy to judge objectively as we can list behaviours

EVALUATION FOR DEFINITIONS OF

ABNORMALITY – CULTURAL RELATIVISM

• Cultural relativism (the view that all beliefs, customs, and ethics

are relative to the individual within his own social context. I.e.

behaviour cannot be judged properly unless it is viewed in the

context of the culture in which it originates )

• SI = Behaviours that are statistically infrequent in one culture may be statistically frequent in another
• DfSN = What is socially normal in one culture is not normal in another culture. The classification system was based on the social norms of the dominant culture in the West (white and middle class), yet the same criteria are applied to subcultures in the West
• FtFA = FtFA criteria is likely to result in different diagnoses when applied to people from different cultures (as the standard of one culture is being used to measure another) - This could be why lower-class and non-white patients are more often diagnosed with a mental disorder (due to their lifestyles being different from the dominant culture)
• DfIMH = The criteria here are also culture-bound. If we apply the criteria to non-Western or non-middle-class then there may be more incidence of abnormality

3.2.2 Psychopathology Specification

• Definitions of abnormality, including deviation from social

norms, failure to function adequately, statistical infrequency

and deviation from ideal mental health.

• The behavioural, emotional and cognitive characteristics of

phobias, depression and obsessive compulsive disorder (OCD).

• 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.

• 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.

• The biological approach to explaining and treating OCD: genetic

and neural explanations; drug therapy.

DEPRESSION

• Is classified as a mood disorder

Emotional Characteristics

• At least 5 symptoms must be present to diagnose
  • Including sadness (most common description given such as feeling worthless or empty) or loss of interest and pleasure in normal activities (activities associated with feelings of despair and lack of control)
  • Also anger is associated with depression (towards self or others)

Behavioural Characteristics

• Reduced energy (being tired or wanting to sleep all the time)
• Being agitated and restless (pace around the room, tear at skin)
• Some sleep more, others may experience insomnia
• Some may lose appetite and other may eat considerably more

Cognitive Characteristics

• Negative thoughts like negative self-belief, guilt, sense of worthlessness
• Negative view on the world (expect things to turn out badly)
• Negative expectations about their lives, relationships and the world
  • These can be self-fulfilling (if you believe you will fail you may reduce effort or increase your anxiety and so will fail)

OCD

• Is classified as an anxiety disorder broken into:
  • Obsessions (persistent thoughts)
  • Compulsions (repetitive behaviour) Emotional Characteristics
• Obsessions and compulsions are a source of considerable anxiety and distress
• Sufferers are aware that their behaviour is excessive and this causes feelings of embarrassment and shame
• A common obsession concerns germ which leads to feelings of disgust Behavioural Characteristics
• Compulsive behaviours are performed to reduce the anxiety created by the obsessions
• They are repetitive and unconcealed (e.g. hand washing)
• Patients feel compelled to carry out these actions or something bad will happen
  • This creates anxiety
• Some patients only experience compulsive behaviours with no particular obsession Cognitive Characteristics
• Obsessions are recurrent, intrusive thoughts or impulses that are perceived as inappropriate or forbidden
• These thoughts, impulses or images are not simply excessive worries about everyday problems; but are seen as uncontrollable, which creates anxiety
• They recognise that the obsessional thoughts or impulses are a product of their own mind
• They also, at some point, recognise that the obsessions or compulsions are excessive or unreasonable

BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS

TWO-PROCESS MODEL

• Classical Conditioning: Initiation
  • A phobia is caused through

association (see diagram)

• Operant Conditioning: Maintenance
  • Likelihood of a behaviour being

repeated is increased if the outcome is rewarding

• Here avoidance of the phobic stimulus reduces fear and so is reinforcing (i.e. negative reinforcement )
• Social Learning (not part of the two-process model)
• Phobias may also be acquired through modelling the behaviour of

others (e.g. seeing a parent respond to a spider with fear)

BEHAVIOURAL APPROACH TO EXPLAINING PHOBIAS

TWO-PROCESS MODEL EVALUATION

IMPORTANCE OF CLASSICAL CONDITIONING

• People with phobias often recall a specific event when their phobia appeared (e.g. being bitten by a dog) - However, not everyone who has a phobia can recall an incident (although it may have been forgotten)
• Sue et al suggest that different phobias may be the result of different processes - E.g. Agoraphobics were more likely to cite a specific incident but arachnophobics cite modelling as the cause

DIATHESIS-STRESS MODEL

• We inherit a genetic vulnerability for developing mental disorders but this disorder will only manifest itself if triggered by a life event (e.g. being bitten by a dog)

SUPPORT FOR SOCIAL LEARNING

• An experiment by Bandura and Rosenthal (1966) supported the social learning explanation
• A model acted as if he was in pain every time a buzzer sounded and later on the participants who had observed this showed an emotional reaction to the buzzer, demonstrating an acquired “fear” response

BEHAVIOURAL APPROACH TO TREATING PHOBIAS

SYSTEMATIC DESENSITISATION (SD)

• Patient is taught to associate the phobic stimulus with a new

response (relaxation) so their anxiety is reduced and they are desensitised

• The response of relaxation inhibits the response of anxiety
• Therapist teaches the patient relaxation techniques (focus on

breathing, visualising on a peaceful scene, progressive muscle relaxation)

• Desensitisation Hierarchy used

FLOODING

• This is applied in one session in the presence of the patient’s

most feared situation (lasting around 2-3 hours)

• When adrenaline levels naturally decrease, a new stimulus-

response link can be learned between feared stimulus and relaxation

BEHAVIOURAL APPROACH TO TREATING PHOBIAS

SYSTEMATIC DESENSITISATION (SD) EVALUATION

EFFECTIVENESS

• SD is successful for a range of phobic disorders (McGrath et al, 1990, found

that 75% of patients with phobias responded to SD)

• The key to success is having contact with the feared stimulus ( in vivo

techniques being more successful then in vitro – imaging)

NOT APPROPRIATE FOR ALL PHOBIAS

• Ohman et al (1975) suggest that SD is not as effective in treating phobias

that have an evolutionary survival link (e.g. dark, heights, dangerous animals), than those as a result from personal experience

STRENGTHS OF BEHAVIOURAL THERAPIES

• Behavioural therapies are generally fast and require less effort from the

patients than other psychotherapies (e.g. CBT)

• This lack of “thinking” means the technique is useful for people who lack

insight to their emotions (e.g. children, people with learning difficulties)

• SD can also be self-administered, making it also cheaper

BEHAVIOURAL APPROACH TO TREATING PHOBIAS

OTHER EVALUATION

RELAXATION MAY NOT BE NECESSARY

• Success of SD and flooding may be due to exposure of the feared stimulus than relaxation
• It might also be due to the expectation of being able to cope with the feared stimulus is most important
• Klein et al (1983) compared SD with supportive therapy with patients with social or specific phobias - They found no difference in effectiveness, suggesting that the “active” ingredient in SD or flooding may be the generation of hopeful expectancies that the phobia can be overcome

SYMPTOM SUBSTITUTION

• Behavioural therapies may not work with certain phobias as symptoms are only the tip of the iceberg
• If the symptoms are removed the cause still remains, and symptoms will resurface, possibly in another form ( symptom substitution ) - E.g. the psychodynamic approach, phobias develop due to projection (Little Hans’ fear of his dad was projected onto horses. If he had been treated for his phobia of horses the underlying issue would have remained and resurfaced elsewhere

3.2.2 Psychopathology Specification

• Definitions of abnormality, including deviation from social

norms, failure to function adequately, statistical infrequency

and deviation from ideal mental health.

• The behavioural, emotional and cognitive characteristics of

phobias, depression and obsessive compulsive disorder (OCD).

• 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.

• 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.

• The biological approach to explaining and treating OCD: genetic

and neural explanations; drug therapy.