The definitions of abnormality
The cognitive, behavioural and emotion characteristic of mental illness
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The behavioural approach to phobias

TWO PROCESS MODEL

Acquisition by classical conditioning- learning to associate something we initially have no fear with to something that triggers a response.

Little Albert study

Strengths:

Weaknesses:

Maintenance by operant conditioning- When behaviour is reinforced or punished causing you to be more/less likely to do something. Reinforcement both positive and negative can maintain a phobia. E.g avoiding your phobic stimulus and feeling less anxiety as a good consequence = more likely to avoid next time.

Rats study

Strengths:

Weaknesses:

Strengths:
- The two process model can be applied to develop therapy. If you can learn to be afraid then you can 'un learn' this phobia. = systematic desensitisation and flooding

Weaknesses:
- If we learn phobias through negative association then fear of spiders is unexplained since in the UK spiders are harmless however bad car experiences are very common though fear of cars is very unheard off.
- Evolutionary factors play a part since we inherit fears for survival advantages such as the fear of the dark, snakes etc. All things that could have endangered our ancestors lives.

TREATMENT

Systematic desensitisation (SD) is a behavioral therapy which reduces anxiety towards phobic stimulus through classical conditoning. A new response to the phobic stimulus is learned. The three stage of SD are:

1) The anxiety hierarchy
The patient and therapist create a list from least to most anxiety inducing activities based on their phobia. This hierarchy will later be used in the therapy sessions.

2) Relaxation
The therapist teaches the patient some relaxation techniques which are to be used during the therapy sessions and during exposure to phobic stimulus. This involves breathing exercises, meditation etc.

3) Gradual exposure
Finally the patient is exposed gradually to their phobic stimulus while in a relaxed state, working up the hierarchy they created and only moving on to the next stage when the patients anxiety has reduced back to normal state. Treatment is complete when the patient can remain relaxed in presence of their highest situation on the hierarchy.

Strengths:
- Gilroy et al shows SD is effective
- More suitable for a large range of patients. Someone with learning difficulty's (which is common in people with anxiety disorders) may not understand whats happening during flooding.
- Many patients prefer SD than flooding since it involves less trauma, and includes more focus on relaxation techniques. = Low refusal rates and low attrition rates.

Weaknesses:
- Involves many sessions which means more psychologists time and more money.

Flooding is a behavioural therapy that involves exposing phobic patients to their phobic stimulus but without a gradual build-up in anxiety hierarchy but an immediate exposure to a very frightening situation.

- Flooding stops phobic responses very quickly, this is because without the option of avoidance behaviour the patients quickly learn that the phobic stimulus is harmless. This is called extinction in classical conditioning terms. In some cases the patient may achieve relaxation in the presence of the phobic stimulus because they have been exhausted by the own fear response.

Strengths:
- Its cost effective since its often 1 session with extreme exposure.
-Ougrin study

Weaknesses:
- Less effective for social phobias since these have cognitive aspects, cognitive therapy would be more suited.
-The treatment is traumatic for patients, patients often unwilling to see it through to the end leaving with a greater fear of their phobia than they began. Also a waste of money and time for people to drop out.
- Cant be done with phobias that are dangerous where the patient could be harmed e.g. sharks.
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The cognitive approach to depression

BECK'S COGNITIVE THEORY OF DEPRESSION

Faulty information processing
- When depressed we attend to the negative aspects of a situation and ignore positives. We also tend to blow small things out of proportion and think in back and white terms.

Negative self-schemas
- A schema is a package of ideas and information of something developed through experience, they act as the framework and interpretation of incoming sensory information. Self-schema is that package of ideas that we have about ourselves. A negative self-schema would mean we interpret all information about selfs in a negative away,

The negative triad
Someone develops a negative view of themselves because of three types of negative thinking that occur automatically regardless of the reality of what is happening at the time. These three elements are called the negative triad.

- Negative view of self
- Negative view of the world
- Negative view of the future

Stengths:
-Grazioli and Terry study supports the idea depression is associated with faulty information processing, negative self-schemas and the negative triad of automatic thinking.
-Clark and Beck concluded there was solid support for all these cognitive venerability factors.
-Becks cognitive explanation forms the basis of Cognitive behaviour therapy (CBT), all cognitive aspects of depression can be identified and challenged encouraging the patients to test weather their thoughts are true ,this is a strength as it translates well into a successful therapy.

Weaknesses:
-Extreem cases of depression where the patient is deeply angry cannot be explained by Beck's theory. Some patients hallucinate and have bizarre beliefs.

ELLIS'S ABC MODEL

A Activating event- In contrast to bucks automatic theory ellis focusses on the irrational thoughts being triggered by external events.

B Beliefs- Ellis identifies a range of irrational beliefs e.g the belief we must always succeed, the belief its a major disaster if something goes wrong and the belief that life is always meant to be fair.

C Consequences- When an activating event triggers irrational beliefs there are emotional and behavioural concequences.

Strengths:
- It can lead to successful therapy (REBT), challenging irrational negative beliefs can reduce depression, supported by Lipsky et al

Weaknesses:
- Only partial explains depression, since some cases do follow after an activating event (reactive depression). This is seen as different to the kind that arises without obvious cause.
- Doesn't explain the anger associated with depression or that some patients suffer hallucinations and delusions. Only explains why some people are more venerable to depression than others because of their cognitions.

TREATMENT
Cognitive behaviour therapy is the most commonly used treatment for depression and a range of other mental health problems. CBT starts with an assessment where the patient and therapists work together to clarify the patients problems. They jointly decide goals for the therapy and create a plan to achieve them. A central task is to identify where there may be irrational thoughts that will benefit from being challenged and putting more effective behaviours into place. Some CBT therapies draw from Beck's CBT or from ellis's REBT, most draw from both.

CBT: Becks cognitive therapy
- The application of Beck's explanation of depression. The aim is to identify the automatic aspect of the negative triad and challenge them. It also encourages patients to test the reality of their negative beliefs, therefore can be set homework to record when they enjoyed an event or when people where nice to them (called 'patient as scientist' technique) This way when the patient states in future sessions that no one likes them, the therapist can produce evidence to prove their statements are incorrect.

CBT: Ellis's rational emotive behaviour therapy (REBT)
-Extends the ABC model to ABCDE, the D stands for dispute and E for effect. The central technique of REBT is to identify and dispute irrational thoughts. The therapist identifies irrational beliefs and begin to challenge them by vigorous argument to change the irrational belief and break the link between negative life events and depression. The vigorous argument is the hallmark of REBT and can also include empirical argument (disputing weather theres actual evidence to support beliefs) and logical argument ( disputes weather the negative though locally follows from the facts).

Behavioural activation:
-Alongside the aspects of CBT patients are encouraged to be more active and engage in enjoyable activities, this will provide more evidence for the irrational nature of beliefs.

Strengths:
- Its effective, March et al study supports this.

Weaknesses:
- It may not work in extreme cases where patients cannot motivate themselves to engage with the hard cognitive work of CBT, this is why its common to treat patients with antidepressants along side CBT therapy. This is a weakness since it can't be used as the sole treatment for all cases of depression.
-Success may be due to the patient therapist relationship not the therapy its self. Rosenweig suggests that the differences between methods of different psychotherapy such as CBT and SD aren't that different but share one essential ingredient, the therapist-patient relationship. It may be the quality of the relationship determining success rather than a particular technique.
-Many comparative studies (Luborsky et al) find very small differences supporting the view that simply having an opportunity to talk to someone who will listen could be what matters.
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Biological approach to explaining OCD

GENETIC EXPLANATIONS

Lewis study shows that OCD runs in families, although its probably genetic vulnerability which is passed on not the certainty of OCD. According to the diathesis stress model certain genes leave some people more likely to suffer a mental disorder but it is not certain - Some environmental stress is needed to trigger the condition.

Candidate genes
-Researchers have identified genes which create genetic vulnerability for OCD called candidate genes. Some of these are involved in regulating the development of the serotonin system.

OCD is polygenic
-This means that OCD is not caused by a single gene but several genes. Taylor found evidence of up to 230 different genes may be involved in OCD. Genes that have been studied in relation to OCD include those associated with the action of dopamine as well as serotonin, both these neurotransmitters are thought to regulate mood.

Different types of OCD
- One group of genes may cause OCD is one person and another group of genes cause it in another.Meaning the origin has different causes (Etiologically heterogeneous). There is also some evidence to suggest that different types of OCD are caused by particular genetic variations.

Strengths:
- Nestadt et al twin study supports the idea that people are genetically vulnerable to OCD as a result of genetic make-up.
-

Weaknesses:
- Psychologists have been less sucsessful in pinning down all the genes involved in OCD. This means the genetic explanation is unlikely to be useful as it provides very little predictive value.
- Environental factors can have an impact in the risk of developing OCD, Cromer et al shows this is his study. Suggesting that OCD cannot be fully explained by by genetic origin. It may also be more productive to focus on environmental causes as we can control these more.

NEURAL EXPLANATIONS
The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain.

The role of serotonin
- Seratonin is a neurotransmitter thought to help regulate mood. If a person has low levels of serotonin then normal transmission of mood-relevant information does not occur and mood and other mental processes are affected. At least some cases can be explained by reduced serotonin function.

Decision-Making systems
- Some cases of OCD (hoarding) seem to be due to impaired decison-making. This may be associated with abnormal functioning of the lateral of the frontal lobes of the brain. The frontal lobes are responsible for logical thinking and making decisions.

Strengths:
- There is evidence to support the neural mechanisms in OCD, for example some antidepressants work purely on the serotonin system and are effective in reducing OCD symptoms.
- OCD symptoms form part of a number of other conditions with a biological origin such as parkinson disease this suggests that the biological process that cause the symptoms in those conditions may also be responsible for OCD. (nestasdt et al)

Weaknesses:
- Research has identified other brain systems that may be involved sometimes, but no system has been found to be involved in all cases of OCD meaning we cannot claim to understand the neural explanation of OCD and cannot apply them.
-The neural explanations could be an affect of OCD not a cause.

TREATMENT

Drug therapy
Drug therapy for mental disorders aim to incresse of decrease levels of neuron transmitters in the brain to increase/decrease their activity.

SSRI's
- The standard medical treatment of OCD involves an antidepressant called selective serotonin reuptake inhibitor. The SSRI's block the reuptake of serotonin therefore increasing the levels of serotonin levels in the synapse which continue to stimulate the postsynaptic neruone.

Combining SSRI's with other treatment
-Drugs are often used alongside CBT to treat OCD. Drugs reduce the patients emotional symptoms such as feeling anxious or depressed which allows the patient to engage more effectively in the CBT. Occasionally additional drugs are prescribed along side SSRI'S.

Alternatives to SSRI's
- When SSRI's aren't effective after 3-4 months the dose can be increased or paired with another drug. Different patients respond differently to different drugs therefore alternatives work well for some people and not at all for others.
-Trycylics are sometimes used, they have the same effect on the serotonin system as SSRI's but have more severe side effects. Therefore kept for extreem cases when patients don't respond to SSRI's
-SNRI's increase the level of serotonin and noradrenalin. These too are reserved for extreme cases where patients don't respond to SSRI's.

Strengths:
- Clear evidence for the effectiveness of SSRI's in reducing the severity of OCD symptoms. Soomro et al study supports this.
-Generally cheaper than psychological treatments and non disruptive to patients lives.

Weaknesses:
- Drugs can have side effects, even though SSRI's help some patients others will feel no benefit but suffer the side effects. Some patients get extreme side effects such as blurred vision, indigestion, weight gain, secretion problems etc . This reduced effectiveness since people stop taking the medication.

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Psychopathology