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1

Statistical infrequency

Defining abnormality in terms of statistics– The most obvious way to define anything as ‘normal’ or ‘abnormal’ is in terms of the number of times it is observed.
- Statistics is about analysing numbers

Behaviour that is rarely seen is abnormal

Example:
IQ - Most individuals scoring below 70 are statistically unusual or ‘abnormal’ are diagnosed with intellectual disability disorder.

2

strength of of statistical infrequency

* Strength includes its real life applications.
All assessment of patients with mental disorders includes some comparison to statistical norms.
Intellectual disability disorder demonstrates how statistical infrequency can be used
Statistical infrequency is thus a useful part of clinical assessment

3

limitation of statistical frequency

Limitation is that not everyone unusual benefits from a label When someone is living a happy life there is no benefit to them being labelled as normal
Someone with a very low IQ who was not distressed or out of work, etc would not need a diagnosis of intellectual disability
Being labelled as abnormal might have a negative effect on the way others view them and the way they see themselves.

4

Deviation from social norms

Abnormality is based on social context - when a person behaves in a way that is different from how they are expected to behave
- Societies and social groups make collective judgements about ‘correct’ behaviours in particular circumstances

Three types of consequences for this behaviour:
– relatively few behaviours that would be considered universally abnormal therefore definitions as abnormal
- This includes historical differences within the same society
- For example, homosexuality is viewed as abnormal in some cultures but not others and was considered abnormal in our society in the past

Example: Antisocial personality disorder
- A psychopath is abnormal because they deviate from social norms or standards. They generally lack empathy.

5

limitation 1 of social norms

Could lead to human rights abuse
Can lead to systematic abuse of human rights
EG drapetomania (black slaves trying to escape) or nymphomania (women attracted to working class men) are examples of how diagnosis was used for social control
Such classifications appear ridiculous but some psychologists argue some modern abnormal classifications are abuses of people’s right to be different

6

limitation of social norms

Social norms are culturally relative
A person from one cultural group may label someone from another group as abnormal using their standards rather than the person’s standards.
Eg, hearing voices is socially acceptable in some cultures but would be seen as a sign of abnormality in the UK
This creates problems for people from one culture living within another cultural group

7

failure to function adequately

Inability to cope with everyday living – A person may cross the line between normal and abnormal at the point that they cannot deal with the demands of everyday life – they fail to function

When someone is not coping:
- They no longer conform to interpersonal rules e.g maintaining personal space
- They experience personal distress
- They behave in a way that is irrational or dangerous

Example – Intellectual disability disorder – an example of failure to function adequately

8

Limitation of failure to function adequately

This is a subjective judgment Someone has to judge whether a patient is distressed. Some may be seen as distressed but not suffering
There are methods for making such judgements as objective as possible, including checklists like global assessment of functioning scale
However, the principle remains whether someone, e.g a psychiatrist, has the right to make this judgement.

9

limitation 2 Failure to function adequately

Recognizes patient’s perspective
It is difficult to assess distress
The definition acknowledges the experience of the patient is important
It captures the experience of many people who need help and is useful for assessing abnormality.

Another limitation is that the definition is the same as deviation from social norms so it is hard to say if someone is really failing to function or deviating from social norms. People who live alternative lifestyles or do extreme sports could be seen as behaving differently and if we treat these behaviours as ‘failures’ of adequate functioning we may limit freedom.

10

Deviation from ideal mental health

Changing the emphasis – a different way to look at normality and abnormality is to think about what makes someone ‘normal’ and psychologically healthy and then identify anyone who deviates from this ideal
Inevitable overlap between definitions – Someone’s inability to keep a job may be a sign of their failure to cope with the pressures of work
Or as a deviation from the ideal of successfully working

11

Jahoda listed 8 criteria examples

- We have no symptoms or distress
- We are independent of other people
- We can cope with stress
- We have a realistic view on the world

12

strength of Deviation from ideal mental health

Deviation from ideal mental health is comprehensive Covers a broad range of criteria for mental health
It covers most of the reasons someone would seek help from mental health services or be referred for help
The sheer range of factors discussed in relation to Jahoda’s criteria make it a good tool for thinking about mental health

13

limitation of Deviation from ideal mental health

Unrealistically high standard for mental health
Few people will attain all Jahoda’s criteria for mental health so most of us would be seen as abnormal
Positive side – It makes it clear to people the ways in which they could benefit from seeking help to improve their mental health
However, it is probably of no value in thinking about who might benefit from treatment against the will.

14

Phobias

behavioural
emotional
cognitive

Behavioural

Panic – this may involve a range of behaviours such as crying, screaming or running away from the phobic stimulus
Avoidance – Considerable effort to avoid coming into contact with the phobic stimulus. This can make it hard to go about everyday life, especially if the phobic stimulus is often seen, e.g public places

Emotional

Anxiety and fear – fear is immediate experience when a phobic encounters or thinks about the phobic stimulus. Fear leads to anxiety.
Reponses are unreasonable – Response is widely disproportionate to the threat posed e.g an arachnophobic will have a strong emotional response to a tiny spider

Cognitive

Selective attention to the phobic stimulus – The phobic finds it hard to look away from the phobic stimulus e.g pogonophobic – fear of beards and cannot concentrate if a bearded person was in the room
Irrational – For example, social phobias may involve beliefs such as ‘if I blush people will think I’m weak’ or ‘I must always sound intelligent’

15

Depression

behavioural
emotional
cognitive

Behavioural

Activity levels – sufferers of depression have reduced levels of energy making them lethargic. In extreme cases, this can be so severe that the sufferer cannot get out of bed
Disruption to sleep and eating behaviour- Sufferers may experience reduced sleep (insomnia) or an increased need for sleep (hypersomnia). Appetite may decrease or increase leading to weight loss or gain.

Cognitive

Poor concentration – Sufferers may find themselves unable to stick with a task as they usually would, or they might find simple decision making it difficult.

Emotional

Lowered mood – More pronounced than the daily experience of feeling lethargic or sad often describing themselves as ‘worthless’ or ‘empty’.
Anger – On occasion, such emotions lead to aggression or self-harming behaviour
Absolutist thinking – ‘Black and white thinking’, when a situation is unfortunate it is seen as an absolute disaster.

16

Compulsive disorder

behavioural
emotional
cognitive

Behavioural

Compulsions – Actions that are carried repeatedly , e.g handwashing. The same behaviour is repeated in a ritualistic way to reduce anxiety.
Avoidance – The OCD is managed by avoiding situations that trigger anxiety, e.g sufferers who wash repeatedly may avoid coming into contact with germs

Emotional

Anxiety and distress – Obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming
Guilt and disgust – Irrational guilt, for example over a minor moral issue, or disgust which is directed towards oneself or something external like dirt.

Cognitive

Obsessive thoughts – About 90% of OCD sufferers have obsessive thoughts, e.g recurring intrusive thoughts about being contaminated by dirt or germs.
Insight into excessive anxiety – awareness that thoughts and behaviour are irrational. In spite of this, suffers experience catastrophic thoughts and are hypervigilant, i.e ‘over-aware’ of their obsession.

17

Explaining phobias

The two-process model - Orval Hobart Mowrer argued that phobias are learned by classical conditioning and maintained by operant conditioning (2 processes involved).

Classical conditioning – involves learning by association and occurs when two stimulus’ are paired together a UCS and an NS. The NS eventually produces the same response that was first produced by the unlearned stimulus alone

1. UCS (unconditioned stimulus) triggers a fear response (fear is a UCR – unconditioned response), e.g. being bitten creates anxiety
2. NS (‘neutral stimulus’) is associated with the UCS, e.g being bitten by a dog (the dog previously did not create anxiety)
3. NS becomes a CS (conditioned stimulus) producing fear (which is now the CR). The dog becomes a CS causing a CR (conditioned response) of anxiety/ fear following the bite

18

Little Albert

Little Albert conditioned fear: Watson and Reynor showed how fear of rats could be conditioned in ‘little albert’.
1. Whenever Albert played with a white rat, a loud noise was made close to his ear. The noise (UCS) caused a fear response (UCR)
2. Rate (NS) did not create fear until the bang and the rat had been paired together several times
3. Albert showed a fear response (CR) every time he came into contact with the rat
(now a CS)

Generalisation of fear to other stimuli – For example, Little albert also showed a fear in response to other white furry objects including a fur coat

19

operant conditioning The two process model

Maintenance by operant conditioning – Operant conditioning takes place when our behaviour is reinforced or punished.
- Negative reinforcement- An individual produces behaviour that avoids something unpleasant
- When a phobic avoids a phobic stimulus, they escape the anxiety that would have been experienced. This reduction in fear negatively reinforces the avoidance behaviour and the phobia is maintained.
- For example, if someone has a morbid fear of clowns, they will avoid circuses and other situations where they ay encounter clowns. The relief felt from avoiding clowns negatively reinforces the phobia and ensures it is maintained rather than confronted.

20

strength of two-process model

Good explanatory power
Two-process model went beyond Watson and Rayner’s conditioning of phobias
It has important implications for therapy. If patient is prevented from practising their avoidance behaviour, then phobic behaviour declines
The application to therapy is a strength of the two-process model

21

Limitations of two processes model

There are alternative explanations for avoidance behaviour
- There is evidence that at least some avoidance behaviour is motivated by positive feelings of safety eg in complex behaviour, like agoraphobia
- This explains why some agoraphics are able to leave their house with a trusted friend with relatively little anxiety, but not alone.
- This is a problem for the 2-process model, which suggests that avoidance is motivated by anxiety reduction.

An incomplete explanation of phobias
-Even if we accept that classical and operant conditioning are involves in phobias, there are some aspects that require further explaining
-We easily acquire phobias of things that were a danger in our evolutionary past eg, fear of snakes. This is biological preparedness – We are innately prepared to fear some things more than others.
-The phenomenon of biological preparedness is a problem for the two-process model because it shows there is m ore acquiring phobias than simple conditioning

Not all bad experiences lead to phobias
-Sometimes phobias do appear following a bad experience and it is easy to see how they could be the result of conditioning - However, sometimes people have a bad experience and don’t develop a phobia e.e being bitten by a dog
-This suggests that conditioning alone cannot explain phobias. They may only develop where vulnerability exists.

22

Treating phobias

Systematic desensitisation (SD) – based on classical conditioning, counterconditioning and reciprocal inhibition
- The therapy aims to gradually reduce anxiety through counterconditioning
• Phobia is learned so that phobic stimulus (CS) produces fear (CR)
• CS is paired with relaxation and this becomes the new CR
- Reciprocal inhibition: It is not possible to be afraid and relaxed at the same time, so one emotion prevents the other

23

Hierarchy when treating phobias

Formation of an anxiety hierarchy – Patient and therapist design an anxiety hierarchy – a list of fearful stimuli arranged in order from least to most frightening
- An arachnophobic might identify seeing a picture of a small spider as low on their anxiety hierarchy and holding a tarantula as the final item.

Relaxation practised at each level of the hierarchy – Phobic individual is taught relaxation technique such as deep breathing or meditation
- Patient then works through the anxiety hierarchy. At each level the phobic is exposed to the phobic stimulus in a relaxed state
- This takes place over several sessions starting at the bottom of the hierarchy. Treatment is successful when the person can stay relaxed in situations high on the hierarchy

24

Strengths of SD

Very effective
- Gilroy et al followed up 42 patients who had SD for spider phobia in three 45-minute sessions At both three and 33 months, the SD group were less fearful then the control group treated by relaxation without exposure
-This shows that SD is helpful in reducing the anxiety in a spider phobia and that the effects of the treatment are long lasting.

suitable for diverse group of patients
-The alternative to SD such as flooding and cognitive therapies are not well suited to some patients
-E.G, having difficulties can make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies which require reflextion
-For these patients, SD is probably the most appropriate treatment

Tends to be acceptable to patients
-Patients prefer it, those given the choice of SD or flooding tend to prefer SD This is because It does not cause the same degree of trauma as flooding. It may also be because SD includes elements that are actually pleasant such as time talking to a therapist.
-This is reflected in the low refusal rates (number of patients refusing to start treatment) and low attrition rates (number of patients dropping out of treatment) for SD

25

flooding

Immediate exposure to the phobic stimulus
- flooding involves bombarding the phobic patient with the phobic object without a gradual build up
- An arachnophobic receiving flooding treatment may have a large spider crawl over their hand until they can relax fully (the phobic not the spider)

Very quick learning through extinction
- Without the option of avoidance behaviour, the patient quickly learns that the phobic object is harmless through the exhaustion of their fear response. This is known as extinction.

Ethical safeguards
- Flooding is not unethical but it is an unpleasant experience so it is important that patients give informed consent. They must be fully prepared and know what to expect.

26

2 limitations of flooding

Less effective for some types of phobia
Although flooding is highly effective for treating simple phobias, it appears to be less so for more complex phobias like social phobias
This may be because social phobias have cognitive aspects, e.g a sufferer of social phobia doesn’t simply experience anxiety but thinks unpleasant thoughts about the social situation
This type of phobia may benefit more from cognitive therapies because such therapies tack the irrational thinking.

Flooding is traumatic for patients
Perhaps the most serious issue with the use of flooding is the fact that it is a highly traumatic experience.
The problem is not that flooding is unethical (patients do give informed consent) but patients are often unwilling to see it through to the end Ultimately it means that the treatment is not effective, and time and money are wasted preparing patients only to have them refuse to start or complete treatment.

27

Explaining depression

Beck’s cognitive theory of depression

Faulty information processing – Aaron Beck (1967) suggested that some people are prone to depression because of faulty information processing, i.e thinking in a flawed way
- When depressed people attend to the negative aspects of a situation and ignore positives, they also tend to blow small problems out of proportion and think in ‘black and white’ terms.

Depressed people have negative self-schemas – A schema is a ‘package’ of ideas and information developed through experience. We use schemas to interpret the world, so if a person has a negative self-schema they interpret all information about themselves in a negative way

The negative triad – There are three elements to the negative triad:
• Negative views of the world, e.g. ‘the world is a cold hard place’
• Negative view of the future, e.g. ‘there isn’t much chance that the economy will get any better
• Negative view of the self, e.g. thinking ‘I am a failure’ and this negatively impacts upon self-esteem

28

2 strengths of becks theory

It has good supporting evidence
-For example, Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth
-They found that those women judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression
- These cognitions can be seen before depression develops, suggesting that Beck may be right about cognition causing depression, at least in some cases
The theory has a practical application as a therapy Beck’s cognitive explanation forms the basis of cognitive behaviour therapy (CBT)
- The components of the negative triad can easily be identified and challenged in CBT. This means a patient can test whether the elements of the negative triad are true
- This is a strength of the explanation because it translates well into a successful therapy

29

limitation of becks theory

Does not explain all aspects of depression
-Depression is a complex disorder. Some depressed patients are deeply angry and Beck cannot easily explain this extreme emotion.
-Some depression patients suffer hallucinations and bizarre beliefs, or suffer Cotard syndrome, the delusion that they are zombies (Jarret 2013) - Beck’s theory cannot always explain all cases of depression, and just focuses on one aspect of the disorder

30

Explaining depression
Ellis’s ABC model

A – Activating event
- Albert Ellis suggested that depression arises from irrational thoughts.
- According to Ellis depression occurs when we experience negative events, e.g. failing an important test or ending a relationship

B – Beliefs
- Negative events trigger irrational beliefs, for example:
• Ellis called the belief that we must always succeed ‘musterbation’
• I-can’t-stand-it-it is’ is the belief that it is a disaster when things do not go smoothly
• ‘Utopianism’ is the belief that the world must always be fair and just

C- Consequences
- When activating event triggers irrational beliefs there are emotional and behavioural consequences
- For example, if you believe you must always succeed and then you fail at something, the consequence is depression