Psychopathology Revision Notes

simplypsychology.org/a-level-psychopathology.html

June 4, 2023

Psychopathology refers to the study of mental disorders in terms of their causes,

development, course, classification, and treatment.

Psychopathology describes a wide array of mental health conditions, including but not
limited to depression, anxiety disorders, bipolar disorder, schizophrenia, and various
personality disorders.

Definitions of Abnormality

Statistical Infrequency

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Under this definition of abnormality, a person’s trait, thinking, or behavior is classified as

abnormal if it is rare or statistically unusual. With this definition, it is necessary to be clear
about how rare a trait or behavior needs to be before we class it as abnormal.

For instance, one may say that an

individual with an IQ below or above the
average level of IQ in society is abnormal.

However, this definition obviously has

limitations, it fails to recognize the
desirability of the particular behavior.

Going back to the example, someone who

has an IQ level above the normal average
wouldn’t necessarily be seen as abnormal.
Rather, on the contrary, they would be
highly regarded for their intelligence.

This definition also implies that abnormal behavior in people should be rare or statistically
unusual, which is not the case. Instead, any specific abnormal behavior may be unusual,
but it is not unusual for people to exhibit some form of prolonged abnormal behavior at
some point in their lives.

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Strengths

This definition can provide an objective way, based on data, to define abnormality if an
agreed cut-off point can be identified.

No value judgments are made –Homosexuality was defined as a mental disorder under
early versions of the diagnostic criteria used by psychiatrists and would not be seen as
‘wrong’ but merely as less frequent than heterosexuality.

Limitations

However, this definition fails to distinguish between desirable and undesirable behavior.
Statistically speaking, many very gifted individuals could be classified as ‘abnormal’ using
this definition. The use of the term ‘abnormal’ in this context would not be appropriate.

Many rare behaviors or characteristics (e.g., left-handedness) have no bearing on

normality or abnormality. Some characteristics are regarded as abnormal even though
they are quite frequent. Depression may affect 27% of elderly people (NIMH, 2001). This
would make it common, but that does not mean it isn’t a problem

Deviation from Social Norms

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Deviation from ideal mental health suggests that we define mental illness by looking at
the absence of signs of physical health (Jahoda).

A person’s thinking or behavior is classified as abnormal if it violates the (unwritten) rules

about what is expected or acceptable behavior in a particular social group. Their behavior
may be incomprehensible to others or make others feel threatened or uncomfortable.
Social behavior varies markedly when different cultures are compared.

For example, it is common in Southern Europe to stand much closer to strangers than in
the UK. Voice pitch and volume, touching, the direction of gaze, and acceptable subjects
for discussion have all been found to vary between cultures.

With this definition, it is necessary to consider: (i) The degree to which a norm is violated,
the importance of that norm, and the value attached by the social group to different sorts
of violations. (ii), E.g., is the violation rude, eccentric, abnormal, or criminal?

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Strength

Comprehensive – Covers a broad range of criteria, most of which is why someone would
seek help from mental health services or be referred for help – Makes it a good tool for
thinking about mental health.

This definition gives a social dimension to the idea of abnormality, which offers an
alternative to the “sick in the head” individual.

Limitations

Social norms can vary from culture to culture. This means that what is considered normal
in one culture may be considered abnormal in another. This definition of abnormality is an
example of cultural relativism.

Unrealistic – Most people do not meet all the ideals because few people experience
personal growth all the time – The criteria may be ideals rather than actualities.

One limitation of the deviation of social norms definition is that norms can vary over time.
This means that behavior that would have been defined as abnormal in one era is no
longer defined as abnormal in another.

For example, drink driving was once considered acceptable but is now seen as socially
unacceptable, whereas homosexuality has gone the other way. Until 1980 homosexuality
was considered a psychological disorder by the World Health Organization (WHO), but
today is considered acceptable.

Failure to Function Adequately

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Failure to function adequately (FFA) refers to an abnormality that prevents the person
from carrying out the range of behaviors that society would expect, such as getting out of
bed each day, holding down a job, and conducting successful relationships, etc.

Rosenhan & Seligman suggested seven criteria that are typical of FFA. These include
personal distress (e.g., anxiety or depression), unpredictability (displaying unexpected
behaviors and loss of control), and irrationality, among others. The more features of
personal dysfunction a person has, the more they are considered abnormal.

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To assess how well individuals cope with everyday life, clinicians use the Global
Assessment of Functioning Scale (GAF), which rates their level of social, occupational,
and psychological functioning.

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Strengths

The definition provides a practical checklist of seven criteria individuals can use to check
their level of abnormality.

It matches the sufferers’ perceptions. As most people seeking clinical help believe that
they are suffering from psychological problems that interfere with the ability to function
properly, it supports the definition.

Limitations

FFA might not be linked to abnormality but to other factors. Failure to keep a job may be
due to the economic situation, not to psychopathology.

Cultural relativism is one limitation; what may be seen as functioning adequately in one
culture may not be adequate in another. This is likely to result in different diagnoses in
different cultures.

FFA is context dependent; not eating can be seen as failing to function adequately, but
prisoners on hunger strikes making a protest can be seen in a different light.

Deviation from Ideal Mental Health

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Jahoda suggested six criteria necessary for ideal mental health. An absence of any of
these characteristics indicates individuals as being abnormal, in other words displaying
deviation from ideal mental health.

Resistance to stress: Having effective coping strategies and being able to cope with
everyday anxiety-provoking situations.
Growth, development, or self-actualization: Experiencing personal growth and
becoming everything one is capable of becoming.
High self-esteem and a strong sense of identity: Having self-respect and a positive
self-concept.
Autonomy: Being independent, self-reliant, and able to make personal decisions.

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 Accurate perception of reality: Having an objective and realistic view of the world.

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Limitations

The difficulty of meeting all criteria, very few people would be able to do so, and this
suggests that very few people are psychologically healthy.

Cultural relativism: these ideas are culture-bound, based on a Western idea of ideal
mental health, and should not be used to judge other cultures.

AO2 Scenario Question

Diane is a 30-year-old businesswoman, and if she does not get her own way, she
sometimes has a temper tantrum. Recently, she attended her grandmother’s funeral and
laughed during the prayers. When she talks to people, she often stands very close to
them, making them feel uncomfortable.

Identify one definition of abnormality that could describe Diane’s behavior. Explain your
choice.

(4 marks)

Answer

“Diana’s behavior could be defined as deviating from social norms.

Although she is 30 she still has childish temper tantrums, she acted in a socially abnormal
way at her grandmother’s funeral and she disobeys social norms about how close it is
appropriate to stand to people.

She is deviating from what is regarded as socially normal, thus according to this definition
she would be defined as psychologically abnormal.”

AO2 Scenario Question

The following article appeared in a magazine:

‘Hoarding disorder – A ‘new’ mental illness

Most of us are able to throw away the things we don’t need on a daily basis.
Approximately 1 in 1000 people, however, suffer from hoarding disorder, defined as ‘a
difficulty parting with items and possessions, which leads to severe anxiety and extreme

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clutter that affects living or work spaces.’

Apart from ‘deviation from ideal mental health,’ outline three definitions of abnormality.
Refer to the article above in your answer. (6 marks)

The Biological Approach to OCD

Characteristics of OCD

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Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterized by intrusive

and uncontrollable thoughts (i.e., obsessions) coupled with a need to perform specific
acts repeatedly (i.e., compulsions).

Common clinical obsessions are fear of contamination (esp., being infected by germs),
repetitive thoughts of violence (killing or harming someone), sexual obsessions, and
obsessive doubt. Compulsions are the behavioral responses intended to neutralize these
obsessions.

The most common compulsions are cleaning, washing, checking, counting, and touching.
To the compulsive, these behaviors often seem to have magical qualities. If they are not
performed exactly, “something bad” will happen.

Some O.C.D. sufferers will meticulously perform their rituals hundreds of times and
experience extreme anxiety if prevented from carrying them out. Cleaning/washing rituals
are more common in women; checking rituals are more common in men.

Cognitive (What do you THINK?): Obsessions dominate ones thinking and are persistent
and recurrent thoughts, images, or beliefs entering the mind uninvited and which cannot
be removed. At some point during the course of the disorder, the person has recognized
that the obsessions or compulsions are excessive or unreasonable.

Emotional (How do you FEEL?): Obsessive thoughts often lead to anxiety, worry, and
distress.

Behavioral (How do you BEHAVE?): Compulsions are the repetitive behavioral

responses intended to neutralize these obsessions, often involving rigidly applied rules.
Most OCD sufferers recognize their compulsions as unreasonable but believe something
bad will happen if they don’t perform that behavior.

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A02 Exam Style Question

Steven describes how he feels when he is in a public place.

I always have to look out for people who might be ill. If I come into contact with people
who look ill, I think I might catch it and die. If someone starts to cough or sneeze, then I
have to get away and clean myself quickly.

Outline one cognitive characteristic of OCD and one behavioral characteristic of OCD that
can be identified from the description provided by Steven. (2 marks)

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The approach can also be criticized for ignoring environmental influences. For example,
people are not born with OCD. They might learn it from their environment through the
process of classical and operant conditioning.

Strengths of this approach include its testability via neuroscience research and evidence
for genetic and neurotransmitter involvement in conditions such as schizophrenia. For
example, the dopamine hypothesis argues that elevated levels of dopamine are related to
symptoms of schizophrenia.

Biological explanations are reductionist as they focus on only one factor, and at present,
our understanding of biochemistry is oversimplified. This means other psychological
factors, such as cognitions, are ignored.

The biological explanations are also deterministic because they ignore the individual’s
ability to control their own behavior, which in turn may affect their biochemistry levels.

Genetic Explanations

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Genetics is the study of genes and inheritance. OCD seems to be a polygenic condition,
where several genes are involved in its development. Family and twin studies suggest the
involvement of genetic factors. The prevalence of OCD in the random population (about
2–3%) is the baseline against which the concordance rates can be compared.

The SERT gene (Serotonin Transporter) appears mutated in individuals with OCD. The
mutation causes an increase in transporter proteins at a neuron’s membrane. This leads
to an increase in the reuptake of serotonin in the neuron, which decreases the level of
serotonin in the synapse.

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The COMT gene is a gene that regulates the function of dopamine. It appears that this
gene is also mutated in individuals with OCD. However, this mutation causes the opposite
effect as the SERT mutation discussed above. The mutated variation of the COMT gene
found in OCD individuals causes a decrease in COMT activity and, therefore, a higher
level of dopamine.

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Carey and Gottesman (1981) found that identical twins showed a concordance rate of
87% for obsessive symptoms and features compared to 47% in fraternal twins. This
difference suggests that genetic factors are moderately important.

The higher concordance rate found for identical twins may be due to nurture, as identical
twins are likely to experience a more similar environment than fraternal twins since they
tend to be treated the same.

Genes alone do not determine who will develop OCD—they only create vulnerability.
Thus, they are not a direct cause, as other factors must trigger the disorder.

Evidence for this is that the concordance rates are not 100%, which shows that OCD is
due to an interaction of genetic and other factors.

OCD may be culturally rather than genetically transmitted as the family members may
observe and imitate each other’s behavior, as predicted by social learning theory.
Alternatively, family members might be more vulnerable to OCD because of the stressful
environment rather than genetic factors.

Neural Explanations

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Neural mechanisms refer to brain regions, structures such as neurons, and the
neurotransmitters involved in sending messages through the nervous system.

One region of the brain, the prefrontal cortex (PFC), is involved in decision-making and
the regulation of primitive aspects of our behavior. An overactive PFC causes an
exaggerated control of primal impulses.

For example, after a visit to the bathroom, your primal instinct to survive by avoiding
germs is brought to your attention. You may make the decision to wash your hands to
remove any harmful germs you may have encountered.

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 Once you have performed the appropriate
behavior, the PFC reduces in activation, and
you stop washing your hands and go about
your day. It has been suggested that if you
have OCD, your PFC is over-activated. This
means the obsessions and compulsions
continue, leading you to wash your hands
again and again.

Abnormalities, or an imbalance in the

neurotransmitter serotonin, could also be
related to OCD. Reduced serotonin and
excessive dopamine may cause OCD.

Serotonin is the chemical thought to be involved in regulating mood. OCD patients have
low levels of serotonin.

Additionally, Dopamine is abnormally high in individuals with OCD. High levels of

dopamine have been thought to influence concentration. This may explain why OCD
individuals experience an inability to stop focusing on obsessive thoughts and repetitive
behaviors.

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The brains of OCD patients are structured and function differently from those of other
people. Brain scans of OCD patients reliably show increased activity in the PFC
(Salloway & Duffy, 2002).

Whether low serotonin causes OCD is unknown. All that’s known is that low serotonin and
OCD are related. It is difficult to establish whether the low levels of neurotransmitters
cause OCD, are an effect of having the disorder, or are merely associated. Causation
cannot be inferred as only associations(i.e., correlations) have been identified.

We do not know whether high levels of dopamine cause OCD or whether OCD is caused
by something else and the effect is high levels of dopamine.

The biochemistry hypothesis does not account for individual differences because the
research does not explain why one individual develops OCD and another develops a
different mental disorder because low serotonin levels are also found in other mental

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disorders. Thus, these biochemical abnormalities are not specific to OCD and may be
true of mental distress.

Psychological therapy (CBT) can be a very successful treatment, and this is difficult to
account for in the serotonin hypothesis.

Biological Treatment – Drugs

Two classes of drugs have proved effective in the treatment of obsessive-compulsive

disorder: serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors
(SSRIs). Both classes of drug increase serotonin levels and so support the neural
explanation / biochemical hypothesis.

Drugs that mainly affect neurotransmitters other than serotonin are of little or no value in
treating obsessive-compulsive disorder.

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Studies using drugs have shown a reduction in dopamine levels is positively correlated
with a reduction in OCD symptoms.

Experiments that inject animals with drugs that increase levels of dopamine have caused
the animals to demonstrate OCD-type behaviors.

Drugs that increase serotonin (antidepressants such as SSRIs) have been shown to
reduce OCD symptoms. Soomro et al. found that SSRIs were significantly better than
placebos in reducing symptoms in 17 different clinical trials

But research results relating to serotonin are varied – sometimes symptoms have been
made worse. There is a great deal of contradictory research.

Drugs show only partial alleviation of the symptoms, so the process is not fully
understood. The exact function of neurotransmitters in the development of OCD is far
from understood.

Most SSRIs have side effects that can be unpleasant, e.g., dry mouth, a slight tremor, fast
heartbeat, constipation, sleepiness, and weight gain.

The success of antidepressant drugs as a treatment does not necessarily mean the
biochemicals are the cause of OCD in the first place. This is known as the treatment
etiology fallacy, and, using headaches as an example, aspirin works well as a treatment,
but this doesn’t mean the headache was due to an absence of aspirin.

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Cognitive Approach to Depression

Characteristics of Depression

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Depression is a mood or affective disorder. This mental Illness is a collection of physical,

emotional, mental, and behavioral experiences that are severe, prolonged, and damaging
to everyday functioning.

The criteria for depression to be diagnosed using the DSM-IV-TR is that at least five or
more symptoms of depression should be apparent. The possible symptoms include:

Behavioral (How do you BEHAVE when you’re depressed?): Neglect of personal

appearance, loss of appetite, disturbed sleep patterns (insomnia), loss of energy
(tiredness), withdrawal from others.

Emotional (How do you FEEL when you’re depressed?): Intense sadness, irritability,
apathy (loss of interest or enjoyment), feelings of worthlessness, and anger.

Cognitive (How do you THINK when you’re depressed?): Negative thoughts, lack of
concentration, low self-esteem, poor memory, recurrent thoughts of death, and low
confidence.

The cognitive approach believes depression stems from faulty cognitions about others,
our world, and us. This faulty thinking may be through cognitive deficiencies (lack of
planning) or cognitive distortions (processing information inaccurately). These cognitions
cause distortions in the way we see things and cause behavior such as depression.

Ellis suggested depression occurs through irrational thinking, while Beck proposed the
cognitive triad.

AO2 Scenario Question

Ben recently moved away from home to go to university. He loved his new life of going
out, meeting new friends, and his new university course. However, after a while, he
struggled to get out of bed and started to become very tired.

His eating patterns changed, and he lost a lot of weight. He noticed that he got angry at
little things and snapped at his friends. When he sat in lectures, he found it hard to
concentrate for long periods of time.

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Identify the behavioral, emotional, and cognitive aspects of Ben’s state. (3 marks)

Beck’s Negative Triad

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The cognitive triad is three forms of negative (i.e., helpless and critical) thinking that are
typical of individuals with depression: namely, negative thoughts about the self, the world,
and the future. These thoughts tended to be automatic in depressed people as they
occurred spontaneously.

For example, depressed individuals tend to view themselves as helpless, worthless, and
inadequate. They interpret events in the world in an unrealistically negative and defeatist
way, and they see the world as posing obstacles that can’t be handled.

Finally, they see the future as totally hopeless because their worthlessness will prevent
their situation from improving.

The negative triad interacts with negative schemas and cognitive biases to produce
depressive thinking.

Cognitive biases are distortions of thought processes. Individuals with depression are
prone to making logical errors in their thinking, and they tend to focus selectively on
certain negative aspects of a situation while ignoring equally relevant positive information.

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In addition to cognitive biases, the negative triad is also influenced by schemas. In
essence, schemas can be seen as deeply held beliefs that have their origins primarily in
childhood. Beck believed that depression-prone individuals develop a negative self-
schema. They possess a set of beliefs and expectations about themselves that are
essentially negative and pessimistic.

Beck claimed that negative schemas might be acquired in childhood as a result of a

traumatic event (e.g., parental or peer rejection). Schemas influence how a person
interprets events and experiences in their life. Beck predicted that in depression, ‘latent’
(i.e., dormant) negative schemas that have been formed in childhood become activated
by life events or ongoing stressors.

Negative schemas and cognitive biases maintain the negative triad, a pessimistic view of
the self, the world (not being able to cope with the demands of the environment), and the
future.

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It may be that negative thinking generally is also an effect rather than a cause of
depression. Perhaps individuals only start experiencing negative thoughts after having
developed depression. However, evidence that negative thinking can be involved in the
development of depression was obtained by Lewinsohn et al. (2001).

They measured negative thinking in non-depressed adolescents. One year later, the life
events of participants over the previous 12 months were assessed, as also whether they
were suffering from depression.

The results showed those who had experienced many negative life events had an
increased likelihood of developing depression only if they were initially high in negative
attitudes. This study supports the theory that negative beliefs are a risk factor for
developing depression when exposed to stressful life events.

The cognitive approach to depression is limited in that genetic factors are ignored.

Little attention is paid to the role of social factors relating to life events and gender in the
cognitive explanation of depression.

Ellis’ ABC Model

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Albert Ellis (1957, 1962) proposes that each of us holds a unique set of
assumptions/beliefs about ourselves and our world that serve to guide us through life and
determine our reactions to the various situations we encounter.

Unfortunately, some people’s assumptions are largely irrational, guiding them to act and
react in ways that are inappropriate and that prejudice their chances of happiness and
success. Albert Ellis calls these basic irrational assumptions.

According to Ellis, depression does not occur as a direct result of a negative event but
rather is produced by irrational thoughts (i.e., beliefs) triggered by negative events.

Ellis believes that it is not the activating event (A) that causes depression (C) but rather
that a person interprets these events unrealistically and therefore has an irrational belief
system (B) that helps cause the consequences (C) of depressive behavior.

For example, some people irrationally assume that they are failures if they are not loved
by everyone they know (B) – they constantly seek approval and repeatedly feel rejected
(C). All their social interactions (A) are affected by this assumption, so a great party can
leave them dissatisfied because they don’t get enough compliments.

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The precise role of cognitive processes is yet to be determined. It is not clear whether
faulty cognitions are a cause of psychopathology or a consequence of it.

Sometimes these negative cognitions are, in fact, a more accurate view of the world:
depressive realism.

Cognitive theories lend themselves to testing. When experimental subjects are

manipulated into adopting unpleasant assumptions or thoughts, they become more
anxious and depressed (Rimm & Litvak, 1969).

Treatment – CBT

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How would you use the therapy?

Cognitive behavioral therapy aims to change the way a client thinks by challenging
irrational and maladaptive thought processes, and this will lead to a change in behavior
as a response to new thinking patterns. Specifically, our thoughts determine our feelings
and our behavior.

Therefore, negative – and unrealistic – thoughts can cause us distress and result in
problems. When a person suffers from psychological distress, the way in which they
interpret situations becomes skewed, which in turn, has a negative impact on the actions
they take.

Cognitive therapists help clients to recognize the negative thoughts and errors in logic
that cause them to be depressed. The therapist also guides clients to question and
challenge their dysfunctional thoughts, try out new interpretations, and ultimately apply
alternative ways of thinking in their daily lives.

The clients learn to discriminate between their own thoughts and reality. They learn the
influence that cognition has on their feelings, and they are taught to recognize, observe
and monitor their own thoughts.

The behavior part of the therapy involves setting homework for the client to do (e.g.,
keeping a diary of thoughts). The therapist gives the client tasks that will help them
challenge their own irrational beliefs.

The idea is that the client identifies their own unhelpful beliefs and then proves them
wrong. As a result, their beliefs begin to change. For example, someone who is anxious
in social situations may set a homework assignment to meet a friend at the pub for a
drink.

CBT would be used when a person’s faulty thinking is affecting their life in a negative way.

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A strength of this therapy is that it has shown to be very effective in treating depression; in
fact, it has been shown to produce longer-lasting recovery than antidepressants.

The precise role of cognitive processes is yet to be determined. It is not clear whether
faulty cognitions are a cause of psychopathology or a consequence of it.

Sometimes these negative cognitions are in fact a more accurate view of the world:
depressive realism.

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Cognitive theories lend themselves to testing. When experimental subjects are
manipulated into adopting unpleasant assumptions or thoughts, they become more
anxious and depressed (Rimm & Litvak, 1969).

An important advantage of CBT is that it tends to be short (compared to psychoanalysis),

taking three to six months for most emotional problems. Patients attend a session a
week, each session lasting either 50 minutes or an hour.

Another strength is that it can reduce ethical issues – the way this therapy works is that
the client is actively involved and in control. They feel empowered as they help
themselves.

AO2 Scenario Question

Jack suffers from depression. His symptoms include loss of concentration, lack of sleep,
and struggles to sleep at night. He finds himself having absolutist thoughts that everything
is negative and bad all the time.

How might a cognitive behavior therapist tackle Jack’s depression? (4 marks)

Behavioral Approach to Phobias

Characteristics of Phobias

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Phobias are a type of anxiety disorder. Phobias are characterized by a marked and
persistent fear that is excessive or unreasonable, cued by the presence or anticipation of
a specific object or situation (e.g., flying, heights, seeing blood).

The symptoms of phobias can be placed into one of three categories:

Behavioral (How do you BEHAVE when you see your feared object?): The phobic
stimulus is either avoided or responded to with great anxiety. For example, someone with
a phobia of dogs may cross the road every time they see a dog, therefore receiving
negative reinforcement, which will maintain the phobia. This avoidance could interfere
with the individual’s normal daily routine.

Emotional (How do you FEEL when you see your feared object?): Exposure to a phobic
stimulus nearly always produces a rapid anxiety response.

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Cognitive (What do you THINK about your feared object?): A person would recognize
that the fear is excessive or unreasonable. The person is consciously aware that the
anxiety levels they experience in relation to their feared object or situation are overstated.

The DSM defines three categories of phobias: agoraphobia, social phobia, and specific
phobias. Agoraphobia is a fear of open spaces but is better characterized as a fear of
being away from home.

Social phobias involve intense fear of social situations or having to interact with other
people. Specific phobias relate to a fear of a specific object, such as a spider, or a
situation, such as an enclosed space (claustrophobia).

The Two-Process Model

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The behavioral approach explains the development and maintenance of phobia, mainly
using the theories of classical conditioning and operant conditioning. These were first
combined as a single explanation for phobia by Mowrer in the two-process model of
phobia.

According to behaviorists, phobias are the result of a classically conditioned association

between an anxiety-provoking unconditioned stimulus (UCS) and a previously neutral
stimulus.

For example, a child with no previous fear of dogs gets bitten by a dog and, from this
moment onwards, associates the dog with fear and pain. Due to the process of
generalization, the child is not just afraid of the dog who bit them but shows a fear of all
dogs.

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Operant conditioning can help to explain how the phobia is maintained. The conditioned
(i.e., learned) stimulus evokes fears, and avoidance of the feared object or situation
lessens this feeling, which is rewarding. The reward (negative reinforcement) strengthens
the avoidance behavior, and the phobia is maintained.

A02 Questions

Kirsty is in her twenties and has had a phobia of balloons since one burst near her
face when she was a little girl. Loud noises such as ‘banging’ and ‘popping’ cause
Kirsty extreme anxiety, and she avoids situations such as birthday parties and
weddings, where there might be balloons.

Suggest how the behavioral approach might be used to explain Kirsty’s phobia of
balloons. (4 marks)

AO3

There is empirical support to show how classical conditioning leads to the development of
phobias. Watson and Rayner (1920) used classical conditioning to create a phobia in an
infant called Little Albert. Albert developed a phobia of a white rat when he learned to
associate the rat with a loud noise.

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The behaviorist approach adopts a limited in the origins of a phobia, as it overlooks the
role of cognition. Ignoring the role of cognition is problematic, as irrational thinking
appears to be a key feature of phobias.

Tomarken et al. (1989) presented a series of slides of snake and neutral images (e.g.,
trees) to phobic and non-phobic participants. The phobics tended to overestimate the
number of snake images presented.

In theory, anyone could develop a phobia of a potentially harmful object, although this
does not always happen. Despite the fact that most adults have either experienced,
witnessed or heard about car accidents where another person is injured, the phobia of
cars is virtually non-existent.

Seligman (1970) suggests that humans have a biological preparedness to develop certain
phobias rather than others because they were adaptive (i.e., helpful) in our evolutionary
past. For example, individuals that avoided snakes and high places would be more likely
to survive long enough and pass on their genes than those who did not.

The idea of biological preparedness is further supported by Ost and Hugdahl (1981), who
claims that nearly half of all people with phobias have never had an anxious experience
with the object of their fear, and some have had no experience at all. For example, some
snake phobics have never encountered a snake.

The cognitive approach criticizes the behavioral model as it does not take mental
processes into account. They argue that the thinking processes that occur between a
stimulus and a response are responsible for the feeling component of the response.

Treatment – Systematic Desensitization

AO1

Systematic desensitization is a type of behavioral therapy based on the principle of

classical conditioning. This therapy aims to remove the fear response of a phobia and
substitute a relaxation response to the conditional stimulus gradually using counter-
conditioning. This will lead to the extinction of the fear response. There are three phases
to the treatment:

First, the patient is taught a deep muscle relaxation technique and breathing exercises.
E.g., control over breathing, muscle detensioning, or meditation. This step is very
important because of reciprocal inhibition, where one response is inhibited because it is

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incompatible with another. In the case of phobias, fears involve tension, and tension is
incompatible with relaxation.

Second, the patient creates a fear hierarchy starting with stimuli that create the least
anxiety (fear) and building up in stages to the most fear-provoking images. The list is
crucial as it provides a structure for the therapy.

Third, the patient works their way up the fear hierarchy, starting at the least unpleasant
stimuli and practicing their relaxation technique as they go. When they feel comfortable
with this (they are no longer afraid), they move on to the next stage in the hierarchy. If the
client becomes upset, they can return to an earlier stage and regain their relaxed state.

The number of sessions required depends on the severity of the phobia. Usually, 4-6
sessions, up to 12, for a severe phobia. The therapy is complete once the agreed
therapeutic goals are met (not necessarily when the person’s fears have been completely
removed).

Exposure can be done in two ways:

· In vitro – the client imagines exposure to the phobic stimulus.

· In vivo – the client is actually exposed to the phobic stimulus.

Research has found that in vivo techniques are more successful than in vitro (Menzies
and Clarke 1993). However, there may be practical reasons why in vitro may be used.

AO3

Practical Issues

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One weakness of in vitro systematic desensitization is that it relies on the client’s ability to
be able to imagine the fearful situation. Some people cannot create a vivid image, and
thus, systematic desensitization is not always effective (there are individual differences).

Systematic desensitization is a slow process, taking, on average, 6-8 sessions. Although,

research suggests that the longer the technique takes, the more effective it is.

Theoretical Issues

Systematic desensitization is highly effective where the problem is learned anxiety about
specific objects/situations (e.g., phobias). However, SD is not effective in treating serious
mental disorders like depression and schizophrenia.

Studies have shown that neither relaxation nor hierarchies are necessary and that the
important factor is just exposure to the feared object or situation. Therefore, therapies like
flooding may be more effective.

Social phobias and agoraphobia do not seem to show as much improvement. Could it be
that there are other causes for phobias than classical conditioning?

For example, if a fear of public speaking originates with poor social skills, then phobic
reduction is more likely to occur in a treatment that includes learning effective social skills
than systematic desensitization alone.

Empirical Evidence

Rothbaum used SD with participants who were afraid of flying. Following treatment, 93%
agreed to take a trial flight. It was found that anxiety levels were lower than those of a
control group who had not received SD, and this improvement was maintained when they
were followed up six months later.

Ethical Issues

SD creates high levels of anxiety when patients are initially exposed, which raises ethical
issues and so questions of appropriateness. It should be noted that virtual reality therapy
does help resolve these issues.

Treatment – Flooding

AO1

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Flooding (also known as implosion therapy) works by exposing the patient directly to their
worst fears. (S)he is thrown in at the deep end. For example, a claustrophobic will be
locked in a closet for 4 hours, or an individual with a fear of flying will be sent up in a light
aircraft.

What flooding aims to do is expose the sufferer to the phobic object or situation for an
extended period of time in a safe and controlled environment. Unlike systematic
desensitization, which might use in vitro or virtual exposure, flooding generally involves
vivo exposure.

Fear is a time-limited response. At first, the person is in a state of extreme anxiety,

perhaps even panic, but eventually, exhaustion sets in, and the anxiety level begins to go
down. Of course, normally, the person would do everything they can to avoid such a
situation.

Now they have no choice but to confront their fears, and when the panic subsides, they
find they have come to no harm. The fear (which, to a large degree, was anticipatory) is
extinguished.

Prolonged intense exposure eventually creates a new association between the feared
object and something positive (e.g., a sense of calm and lack of anxiety). It also prevents
the reinforcement of phobia through escape or avoidance behaviors.

AO3

Flooding is rarely used, and if you are not careful, it can be dangerous. It is not an
appropriate treatment for every phobia. It should be used with caution as some people
can actually increase their fear after therapy, and it is not possible to predict when this will
occur.

Wolpe (1969) reported the case of a client whose anxiety intensified to such as degree
that flooding therapy resulted in her being hospitalized.

Also, some people will not be able to tolerate the high levels of anxiety induced by the
therapy and are, therefore, at risk of exiting the therapy before they are calm and relaxed.
This is a problem, as an existing treatment before completion is likely to strengthen rather
than weaken the phobia.

However, one application is for people who have a fear of water (they are forced to swim
out of their depth). It is also sometimes used with agoraphobia. In general, flooding
produces results as effective (sometimes even more so) as systematic desensitization.

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The method’s success confirms the hypothesis that phobias are so persistent because
the object is avoided in real life and is therefore not extinguished by the discovery that it is
harmless.

For example, Wolpe (1960) forced an adolescent girl with a fear of cars into the back of a
car and drove her around continuously for four hours: her fear reached hysterical heights
but then receded and, by the end of the journey, had completely disappeared.

What do the examiners look for?

Accurate and detailed knowledge

Clear, coherent, and focused answers
Effective use of terminology (use the “technical terms”)

In application questions, examiners look for “effective application to the scenario,” which
means that you need to describe the theory and explain the scenario using the theory
making the links between the two very clear. If there is more than one individual in the
scenario you must mention all of the characters to get to the top band.

Difference between AS and A level answers

The descriptions follow the same criteria; however, you have to use the issues and
debates effectively in your answers. “Effectively” means that it needs to be clearly linked
and explained in the context of the answer.

Read the model answers to get a clearer idea of what is needed.

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