Defining abnormality:
theyre unable to cope with the demands of every life or
Statistical infrequency
A persons thinking/behaviour is classified as
abnormal if rare or statistically unusual
Falls outside the range thats typical for most people
The average is normal
e.g. one who has an IQ below or above the average level of
IQ in society is abnormal
provide an objective way, based on data, to define
abnormality if an agreed cut-off point can be identified.
definition (unlike DSN) does not make judgements about
the acceptability of behaviour. The behaviour is rare
rather than wrong.
difficult to know where the draw the line between
behaviour that is frequent enough to be normal and rare
enough to be abnormal e.g. depression found in 19%
people aged 16+ with 20% women reporting symptoms
and 18% in men.
fails to distinguish between desirable and undesirable
behavior e.g. high iq is desired but in this definition, it
could be seen as abnormal
cultural and historical relativism whats acceptable in
one culture and time period may not be in another
Deviation from social norms
A persons thinking/behaviour is classified as abnormal if
it violates the unwritten rules about what is expected or
acceptable
Their behaviour may : be incomprehensible to others ;
make others feel threatened / uncomfortable.
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
violation. (ii) E.g. is the violation rude, eccentric,
abnormal or criminal?
gives a social dimension to the idea of abnormality,
which offers an alternative to the 'sick in the head'
individual.
cultural and historical relativism whats acceptable in
one culture and time period may not be in another e.g.
common in Southern Europe to stand much closer to
strangers than in the UK; homosexuality was regarded
as mental illness until 1972, not anymore
cross cultural misunderstanding may contribute to higher
rates in some disorders than it actually is.. high
diagnosis rate of schizophrenia amongst non white
british people
based on context the behaviour occurs e.g. same
behaviour might be normal and abnormal e.g.
undressing in a bathroom or classroom subjective
judgment is necessary human rights abuse when
USSR political dissidents were sent to psychiatric
hospitals for disobeying the political regime
Failure to Function Adequately
A persons thinking/behaviour is classified as abnormal if
experience personal distress e.g. getting out of bed each
day
Rosenhan & Seligman suggested seven criteria for FFA:
o Personal distress (anxiety/depression)
o Unprectability (loss of control/unexpected
behaviours)
o Irrationality / incomprehensibility
((unreasonable/illogical/unjustifiable) / (not able
to be understood))
o Maladaptiveness (danger to self/not adjusting
appropriately to environment)
o Suffering
o Causes observer discomfort
o Violates moral/social standards
provides a practical checklist of seven criteria individuals
can use to check their level of abnormality.
matches the sufferers' perceptions. most people seeking
help believe they are suffering from psychological
problems that interfere with the ability to function
properly
FFA is context dependent E.G. not eating can be seen
as failing to function adequately but prisoners protesting
by hunger strikes isnt; people engage in maladaptive
behavior e.g. smoking, drinking alcohol, but arent
classed as abnormal
Cultural relativism; what may be seen as functioning
adequately in one culture may not be adequate in
another, resulting in different diagnoses e.g. children
carry out work in Gambia that children in western
cultures cannot
Deviation from Ideal mental health
Rather than defining whats abnormal, we define what is
normal/ideal and anything that deviates from it is
abnormal
Jahoda proposed 6 characteristics, absence from these
is considered as abnormal.
o Positive view of self
o Capacity for growth and development
o Autonomy and independence
o Accurate perception of reality
o Positive friendships and relationships
o Environmental mastery meeting the
demands of day to day situations
cultural and historical relativism whats acceptable in
one culture and time period may not be in another e.g.
common in Southern Europe to stand much closer to
 strangers than in the UK; homosexuality was regarded
as mental illness until 1972, not anymore
cross cultural misunderstanding may contribute to higher
rates in some disorders than it actually is.. high
diagnosis rate of schizophrenia amongst non white
british people
Difficulty of meeting all criteria - few people would be
able to do so. This definition suggests we are all
abnormal most of the time so this becomes meaningless
(over inclusive)
Phobias
The DSM defines three categories of phobias:
Specific phobias phobias of particular objects e.g.
dog / specific situations e.g. injection
Social phobias e.g. public speaking
Agoraphobia open/public space
Phobias is a type of anxiety disorder. Phobias are
characterised by excessive or unreasonable persistent fear,
cued by a specific object or situation (e.g. flying, heights,
seeing blood).
Behavioural characteristics
1. Panic in the presence of the phobic object
crying
2. Avoidance when coming into contact
3. Endurance high anxiety when object is present
Emotional characteristics:
1. Anxiety (high level of arousal) and fear
2. Unreasonable emotional responses
disproportionate to danger posed by object
Cognitive characteristics
1. Selective attention to object cant look away from it
2. Irrational beliefs about object e.g. all dogs are
dangerous
3. Cognitive distortions e.g. someone who hates
dogs see them as disgusting
Behaviourist explanation of phobias:
All behaviours are learnt from environment inc
phobias
Through: Classical conditioning learning by
association; operant conditioning learning by
consequences
Classical conditioning:
Behaviour is learnt by associating stimulus (UCS) which
causes fear (UCR) with an object (NS). After pairing the two
stimuli, NS causes the UCR fear and the fear is the
conditioned response
Little Albert (Watson and Rayner)
Conditioned 11 months old to be fearful of white rats by
associating the rat with a loud noise which scared Albert
Little albert:
sees rat (NS) no reaction
heard the noise of a hammer on a mental bar
(UCS), he cried (UCR)
Paired as heard the noise (UCS) whilst presented
with rat (NS), he cried (UCR)
After conditioning: presented with rat (CS), cried
(CR)
Operant Conditioning maintenance of phobia
Behaviour learnt through classical conditioning
weakens but most phobias are long lasting
because:
o People who have phobia tend to get
attention from family and friends (positive
reinforcement) so they repeat their
behavior
o Individual avoids phobic object (negative
reinforcement) prevents unpleasant
feelings of fear and panic so individual will
repeat the behaviour (avoidance)
Two Process Theory argues that phobias are
acquired through classical conditioning but
maintained through operant conditioning
Evaluation:
Behaviourist theory fails to explain why some things
are more lkely to cause phobias. evolutionary
factors might better explain why people are more
likely to fear snakes than lambs and trees. E.g. they
avoiding snakes enhance survival so we might be
genetically programmed to develop phobias of some
stimuli which presented us with danger in our past.
Seligman calls this genetic preparedness.
Reductionist Doesnt take accountother factors
because not everyone who have frightening
experiences develop phobias.
The cognitive approach criticise the behavioural
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.
Empirical evidence exist Little Albert
People might develop phobias by learning through
imitation (social learning theory) but few people with
phobias report observing others and dont develop
their parents phobias

Behavioural treatments
1. Systematic desensitization (Wolpe) uses classical
conditioning to replace the fear response by
relaxation response as its not possible to
experience both simultaneously (called reciprocal
inhibition)
1) Client learns relaxation techniques e,.g. deep
breathing/meditation
2) Hierarchy of fear from least frightening to
most frightening e.g. for dogs: smell, fur, paw,
teeth, dog
3) Work through hierarchy learning to use
relaxation techniques in presence of feared
object and profress up a level when relaxed at
the present level.
4) Number of sessions varis with strength of the
phobia usually 4-6, if severe 12
5) 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.
Vivo techniques are more successful than in vitro (Clarke)
6) If effective, clients have been counter
conditioned new response to a stimulus so no
longer associate object with fear
Evaluation:
Practical issues - in vitro systematic desensitization
is that it relies on the clients 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).
Its a slow process, taking ave 6-8 sessions. Although
research suggests that the longer the technique takes the
more effective it is.
Theoretical Issues McGrath found its effective for
75% of people with specific phobias but not
effective for disorders like depression and
schizophrenia.
Marks says its effective because of exposure to feared
stimulus not relaxation so relaxation and hierarchy is
unnecessary. Effectiveness is explained in terms of cognitive
restructuring rather than classic learning theory.
Flooding may be more effective.
Social phobias and agoraphobia dont improve much,
perhaps there are other causes for phobias than classical
conditioning. E.g. if a fear of public speaking comes from
poor social skills then reduction of phobia through learning
effective social skills could be better than just systematic
desensitization.
Empirical Evidence - Rothbaum used SD with Ps
who had flying phobia. 93% took the trial flight.
Found that anxiety levels were lower than of a
control group who didnt receive SD and this
improvement was maintained when they were
followed up 6 months later.
Comer OCD , 60% improved
Ethical Issues - SD creates high levels of anxiety
when patients are initially exposed, which also
questions appropriateness. Virtual reality therapy
does help resolve these issues.
Flooding
Flooding works by exposing the patient directly to the phobic
object. For example an individual with a fear of flying will be
sent up in a light aircraft.
Exposes sufferer to the phobic object for an extended period
of time in a safe and controlled environment
generally involves vivo exposure.
At first the person is in a state of extreme anxiety, even panic,
but eventually exhaustion sets in and anxiety level go down.
Normally the person would do everything they can to avoid
the situation. Here, they have no choice but confront their
fears so ] panic subsides and they find their phobic object
causes no harm
The fear (which to a large degree was anticipatory) is
extinguished.
Classical conditioning: learnt response is removed when CS
(e.g. dog) is seen without the US (being bitten)
Prolonged exposure creates a new association between
feared object and something positive (e.g. a sense of calm
and lack of anxiety). Also prevents reinforcement of phobia
through escape or avoidance behaviours.
Evaluation:
Used as last resort because its dangerous and not
appropriate for every phobia as some peoples fear
may strengthen instead and it the results are
unpredictable. Wolpe - clients anxiety intensified so
much she got hospitalised.
Ethical issues may cause psychological harm as it
puts clients in an uncomfortable situation.
Depends how willing the client is to do the therapy -
might exit the therapy before theyre calm which
could strengthen rather than weaken the phobia
Becks Negative Triad
Suggest depression is the result of holding negative
schemas about the world, self and the future.
Schema is a packet of information about situations, people
and objects and we acquire these through experience.
People with depression are more prone to developing
negative schemas as they think of themselves in a
pessimistic way.
Negative schemas are acquired through childhood from
traumatic events e.g. rejection.
For example,
Negative view of the self: I am worthless. helpless
Negative view of the world: Everyone hates me because I
am worthless see the world in an unrealistic, defeatist way
and that they cannot handle any obstacles
Negative view of the future: I will never be good at anything
and everyone hates me hopeless as their worthlessness
obstructs improvement

Effective for specific phobias but not as effective for

social phobias because they include cognitive
elements.

People with specific phobias can lose it after 3

sessioms (Mark) cost effective and not as lengthy

Depression

Depression is a mood, or affective disorder.

The criteria for depression to be diagnosed using the DSM-

IV-TR, min. 5 or more symptoms of depression should be
seen:

Behavioural:
These beliefs lead to cognitive biases selecting onfly
Disturbed sleeping patterns (insomnia) and eating
confirming events for attention events which show youre
behaviour (loss)
worthless ignores positive information
Aggression and self harm
Activity level e.g. loss of energy
Ellis ABC model
depression does not occur as a direct result of a negative
Emotional:
event but rather is produced by the irrational thoughts (i.e.
Extreme sadness
beliefs) triggered by negative events.
Anger
Apathy (loss of interest of enjoyment)
Lowered self esteem

Cogntiive:
Negative, irrational
Lack of concentration
Poor memory
Low confidence

Cognitive approach:
depression is caused by cognitive deficiencies (lack of
planning) or cognitive distortions (processing information
inaccurately)
Ellis believes : activating event (A) doesnt cause depression
(C), but rather that a person interpret these events
unrealistically and therefore has an irrational belief system
(B) that helps cause the consequences (C) of depressive
behaviour.
For example, some people irrationally assume that they are
failures if not loved by everyone they know (B) - they
constantly seek approval and feel rejected (C). Their social
interactions (A) are affected by this assumption, so that a
great party can leave them dissatisfied because they dont
get enough compliments.
Evaluation:
Could be that negative thinking is an effect rather than the
cause of depression. Perhaps individuals only get negative
thoughts after developing depression. But, Lewinsohn et al.
proves it is part of the development (evidence)
measured negative thinking in non-depressed
adolescents
1 year later, their life events from prev. 12 months were
assessed and whether theyre suffering from depression
showed those who experienced many negative life
events had increased chances of developing depression
supports negative beliefs triggers depression
Reductionist
o genetic factors are ignored and Doesnt explain why
people who have depression have low level of
serotonin
o Not explain social factors relating to life events and
gender in the cognitive explanation of depression.
Suggests its the patients fault, not the situation they are in
prevents clients to assess their situation and take action to
improve the factors causing difficulties
Some irrational beliefs are realistic and realistic (Alloy
Abrahmson) could be a rational response to negative
siutations - Sometimes these negative cognitions are in fact a
more accurate view of the world: depressive realism.
Effective therapy, unlike drugs, no side effects
Cognitive treatments of depression
Cognitive Behaviour therapy:
As cognitive approach assumes that the cause of mental
disorders is maladaptive and irrational thinking, the aim of
this therapy is to challenge the clients thinking and help them
change their beliefs to more adaptive ones.
Rational-Emotive-Behaviour therapy (CBT) Ellis
Identify maladaptive, irrational thoughts and
consequences they bring
Therapist disputes the belief and show its not true
3 types of disputing
o Logical (does it make sense?)
o Empirical (is it consistent with reality?)
o Pragmatic (is this belief helpful in clients
life?)
Clients are asked to do hw on these thoughts
goals set to think in a more adaptive way e.g. focus
on clients success and build on those
Focus on present situation, only look back when
useful i.e. learn from it
Clients are encouraged to become more active
(behavioural activation) in pursuing pleasurable
activities
Therapist must provide respect and appreciation
regardless of what client says (unconditional
positive regard)
Evaluation:
Gives individuals responsibility which is empowering and
can boost self esteem but can be overwhelming to some
which can further strengthen their depression
Less time consuming than psychoanalysis but requires
commitment from clients who might not have motivation
ie. People with severe depression
No negative side effects but doesnt work as fast as drug
treatment
Suitable for a lot of mental disorders but requires client
to communicate effectively so it might not be suitable for
clients with severe disorders like schizo.
Long term benefits: clients learn skills they can
continually use and stops symptoms from returning.
Fava et al 80% of patients on drug treatment for
depression relapsed after 2 years whereas only 30% for
those using drugs followed by CBT
Could be that the relationship between client and
therapist which leads to improvement as they have
someone to share concerns with they feel supported
from someone
Behavioural activation contributes to improvement as
people might make new friends and get positive
feedback from their activities.
 Expensive but access isnt limited by money as its
available on NHS
Obsessive Compulsive Disorder (OCD)
anxiety disorder characterised by frequent intrusive and
uncontrollable thoughts (i.e. obsessions), coupled with a
need to perform specific acts repeatedly (i.e. compulsions).
e.g. Fear of contamination (esp. being infected by germs) -
compulsions are the behavioral responses intended to
neutralize these obsessions
Most common compulsions are cleaning, washing, checking,
counting and touching - if theyre not performed exactly
something bad will happen
Behavioural:
Compulsive behaviours: repetitive behaviours, reduce
anxiety for a short while
Avoidance: OCD sufferers will tend to avoid the
situations that might trigger their anxiety
Emotional:
Anxiety and distress/worry
Accompanying depression
Cognitive characteristics
Obsessive thoughts (recurring thoughts, persistent
and uncontrollable)
Cognitive strategies to deal with obsessions
Insight into excessive anxiety: OCD sufferers aware
that their obsessions and compulsions are irrational
Biological explanations of OCD: Genes
Genetics is the study of genes and inheritance.
OCD seems to be a polygenic condition, where a number of
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 23%) is the baseline against which the concordance
rates can be compared.
The SERT gene (Serotonin Transporter) are mutated in
individuals with OCD = increase in transporter proteins at a
neurons membrane = increase in the reuptake of serotonin
into the neuron which decreases the level of serotonin in the
synapse.
The COMT gene - regulates the function of dopamine.
Itsmutated in individuals with OCD = causes a decrease in
the COMT activity = higher level of dopamine.
Diathesis- stress model: genetic mutations in COMT/SERT
=vulnerability to OCD but other stressors must be present to
develop fully
Evaluation:
Carey and Gottesman - identical twins: concordance rate of
87% for obsessive symptoms and features compared to 47%
in fraternal twins, suggests genetic factors are moderately
important.
The higher concordance rate found for identical twins twins
may be due to nurture as identical twins 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 OCDonly
create vulnerability. 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.
The OCD may be culturally rather than genetically
transmitted as the family members may imitate each others
behaviour (social learning theory). Family members might be
more vulnerable to OCD because of the stressful
environment, not genetic factors.
Biological explanations of OCD: Neural explanation
Neural mechanisms refer to regions of the brain, structures
such as neurons and the neurotransmitters involved in
sending messages through the nervous system.
the prefrontal cortex (PFC), is involved in decision making
and the regulation of primitive aspects of our behaviour. An
over active PFC, causing 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.
Once you have performed the appropriate behaviour, 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.
COMT and SERT code for amount of dopamine and
serotonin (regulates mood) produced high dopamine
(influence concentration hence inability to stop obsessive
thoguhts and repetitive behaviour), low serotonin (lowers
mood) involved in OCD
Evaluation
Brains of OCD patients are structured and function differently
from those of other people. PET scans of OCD patients
reliably show increased activity in the PFC (Salloway &
Duffy).

When treated with drugs (SRI/SSRI)so serotonin level

increase, symptoms decrease = support involvement of
serotonin in OCD

Lack of support - 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.
Only associations(i.e. correlations) have been identified not
causations.

The biochemistry hypothesis doesnt take in individual

differences reductionist - research doesnt explain why one
develops OCD and another different mental disorder when
low serotonin levels are also found in other mental disorders.
Biochemical abnormalities are not specific to OCD, and may
be true of any form of mental distress.

Psychological therapy (CBT) can be very successful

treatment and this is difficult to account for in the serotonin
hypothesis.
Anti anxiety drugs: e.g. Valium
Biological treatment of OCD: Drugs:
Slow down activity of CNS enhances activities of GABA
Anti depressants also known as: (gamma aminobutyric acid) slows down the worry circuit in
the brain.
serotonin reuptake inhibitors (SRIs)
selective serotonin reuptake inhibitors (SSRIs). E.g. prozac
Blocks the reuptake channel on neurons and so serotonin
increase in synapses, and so support the neural Evaluation:
explanation / biochemical hypothesis
improve mood and reduce anxiety which is experienced by Can be effective, allows people to have a normal life
patients with OCD. - Soomro meta analysis 17 studies comparing
placebos to SRRIs found SRRI more effective than
placebos

drugs have shown a reduction in dopamine levels is

positively correlated with a reduction in OCD
symptoms.
Cheaper compared to psychological treatments, like
CBT. beneficial for health service providers.

Relapse rates shows drug treatment is not long-

lasting and dont cure disorder , only controls
symptoms. Simpson et al -during the 12 weeks
following the end of treatment, 45% patients
relapsed back into the disorder compared to only
12% of those who had received CBT- more effective
with psychological therapy like CBT.

Drugs dont teach patients skills to deal with their

disorder, unlike with CBT
 Not suitable for everyone as doesnt take individual
differences may cause varied unpleasant side
effects e.g. dry mouth, sleepiness, and weight gain
patients reluctant to take them higher drop out
rate. can also be addictive
headaches, aspirin works well as a treatment but
this doesnt mean the headache was because of the
absence of aspirin shows function of
neurotrasmitters is not fully understood.

Lacks research - success of antidepressant drugs

as a treatment doesnt necessarily mean
biochemicals are the cause of OCD in the first place
(known as the treatment aetiology fallacy) e.g.