Depression is a complex mental illness with no single cause. Biological causes include genetic factors (which render people vulnerable to acquiring depression), structural and functional neurobiological abnormalities, bad sleep hygiene and disruptions in circadian rhythm. Personal factors such as a person’s temperament, characteristics, cognitive biases, coping strategies and the way in which we deal with others can leave anyone vulnerable to the mood disorder. Psychoanalytic causes include self- directed anger, low self- esteem or loss of an attachment or independence. Cognition and behaviour may cause depression as depressed individuals tend to interpret situations in a depressive thinking style, leading to cognitive distortions. Lack of response- contingent positive reinforcement (RCPR) can also maintain the depressive state. Finally family based stress, belief systems and interaction patterns all hold a role in the aetiology and maintenance of depression.
What Treatments are Effective for Depression?
Whilst anti- depressants do not actually treat depression, they do however reduce the symptoms, as they normalize the disturbed monoaminergic systems which are assumed to be responsible for the clinical features of depression. Behavioural therapy based on classical conditioning, functions on the idea that all behaviour is learned and therefore unhealthy behaviours can be changed as it seeks to identify and help change potentially self-destructive or unhealthy behaviours. Cognitive therapy aims to change any unhelpful or inaccurate thinking, problematic behaviour, and distressing emotional responses. This treatment teaches clients’ to develop skills to control their cognition in terms of reducing depressive thinking, relating to others in different ways, and changing behaviours. Family therapy directly involves all family members and the patient and focuses on the relationships and communication of families in order to work through clinical problems.
2. Schizophrenia
What Causes Schizophrenia?
Genetics has a role to play but is not said to cause schizophrenia directly, however it is believed that one can inherit a disposition to the illness. Biological factors include abnormal neuroanatomical development as a result pre or peri- natal factors, excessive synaptic pruning in adolescence or exposure to stress. Abnormal neurotransmitter activity such as excessive levels of dopamine can cause positive symptoms and reduced glutamate activity causes negative symptoms. Life history factors such as cannabis use or a serious trauma can also cause the disorder. Those considered to have a ‘schizotypal personality’ with odd or eccentric traits may also be vulnerable to the disorder. The stress- vulnerability model states that the combination of these two factors is what causes the disorder- no single cause itself.
What Treatments are Effective for Schizophrenia?
It has been found that patients with schizophrenia achieve the best outcomes when treated with a combination of medication and psychological interventions and are less likely to relapse. The most effective pharmacological treatment is considered to be dopamine-2 antagonists, which blocks dopamine receptors by receptor antagonism, controlling clients’ positive symptoms. Psychological treatments include family therapy, aiming to reduce familial stress and improve medication adherence. Cognitive behaviour therapy also improves medication adherence as well as regulating mood and positive symptoms and helps patients’ maintain a daily routine. Other treatments include; cognitive remediation therapy which improves patients’ attention, memory and planning skills; social skills training, helping clients enhance their communication and social problem solving; and vocational rehabilitation, allowing patients to develop a working lifestyle.
3. Anxiety
What are the main anxiety disorders?
The title ‘anxiety’ is more like an umbrella term for several distinct disorders. Separation anxiety involves a persistent, excessive worry about the separation or loss of home or from people who are close to the patient. Selective mutism refers to an individual, normally capable of speech who becomes unable to speak certain situations or to specific people and is more commonly found in children. Phobias refer to the intense and persistent fear experienced by a patient towards a certain object, event or situation which is out of proportion to the danger posed by the stimulus. Social anxiety disorder is the fear of being negatively evaluated by others. Generalized anxiety disorder involves excessive, uncontrollable and often irrational worry certain situations, events or activities. Panic disorders involve reoccurring panic attacks. Post- Traumatic Stress Disorder (PTSD) occurs after a trauma and involves recurrent intrusive traumatic memories and intense anxiety. Obsessive Compulsive Disorder involves distressing obsessions and compulsive practices that reduce anxiety associated with obsessions.
What treatments are effective for anxiety disorders?
Currently, the best practice is a stepped care approach, involving self- help interventions and guidance. Exposure therapies have been found to be very useful in treating anxiety disorders as habituation to the previously threatening stimulus can occur. Psychoeducation provides patients with information and support to help them better understand and manage their illness. Developing cognitive coping skills allows patients to challenge ‘dangerous thinking’ as they learn to recognise distortion, tolerate uncertainty and use mindfulness techniques. Familial involvement is also important when treating an anxiety disorder as it can stop ‘danger talk’ and reinforcing avoidance as well as offering support and encouragement. Medication such as SSRIs have proved to be helpful for some anxiety disorders, however, should be taken with caution as selective serotonin reuptake inhibitors may increase suicide risk.
4. Childhood Disorders
What are some of the main causes of ADHD, conduct disorder (CD) and oppositional defiant disorder (ODD)?
Biological, cognitive-behavioural and family systems theories have been developed to explain the aetiology of ADHD. Biological theories focus on the role of genetic factors, structural brain abnormalities, neurotransmitter dysregulation, dietary factors and hypo-arousal in causing the disorder. Cognitive behavioural theories state that inattention, hyperactivity, impulsivity and deficits in executive functioning are underlying causes of ADHD. Family systems theory postulates that ADHD symptoms are maintained by both family factors and community factors. Biological causes of CD or ODD looks at the roles of genetic factors, neurobiological deficits, neurotransmitter dysregulation, neuroendocrine factors, arousal levels, temperament and neuropsychological deficits. Psychodynamic theorists state that CD or ODD is caused by deficits in the superego and attachment theory to the role of insecure attachment. Cognitive behavioural theories argue that problems with social information processing and social skills deficits being principal factors in causing CD or ODD. Behavioural theories focus on the role of reinforcement contingencies in the maintenance of conduct problems.
What treatments are effective for ADHD, CD & ODD?
A successful treatment for ADHD involves a combination of stimulant therapy, which uses stimulants (e.g., methylphenidate) as part of multimodal treatment programmes and behaviour control, which uses intense, immediate, salient reinforcers. Allergen free diet for children who have food allergies has also proved to treat the disorder. For patients with more limited conduct problems (typically children with ODD), behavioural parent training is currently the treatment for which there is greatest empirical support. For more widespread conduct problems (typical with children with CD) family therapy, multisystemic therapy and treatment foster care are currently the treatments for which there is greatest empirical support.
5. Personality Disorders
What are the main personality disorders?
According to the DSM V, personality disorders can be classified into three clusters. Cluster A, the odd, eccentric group, which consists of paranoid personality, schizoid personality disorder and schizotypal personality disorder. Cluster B, the dramatic, emotional, erratic group consists of antisocial personality disorder; borderline personality disorder; histrionic personality disorder; narcissistic personality disorder. Finally, cluster C, the anxious, fearful group of personality disorders includes; avoidant personality disorder; dependent personality disorder; obsessive-compulsive personality disorder.
Name some treatments that are effective for certain personality disorders.
Randomised controlled trials showed that some symptoms of personality disorders respond to medication; anti- psychotics reduce the psychotic- like symptoms common in the disorders of cluster A; mood stabilizers reduce aggression, common in cluster B personality disorders; and antidepressants regulate mood, common the disorders cluster C and borderline personality disorder. Dialectical Behavioural therapy which allows clients to learn behavioural techniques to motivate themselves to use these skills, within a strong therapeutic alliance has been found to be an effective treatment. Transference focused psychotherapy has been found to be effective when treating borderline personality disorders as it helps clients understand how their relationship difficulties arise from using their defence mechanisms of splitting and projection as well to develop less extreme and opposing ways of managing strong emotions and relationships. Psychodynamic and cognitive behavioural treatments are effective for some personality disorders as well as short-term psychodynamic psychotherapy proving useful for cluster C personality disorders
6. Models of Abnormal Behaviour
List the main models of abnormal behaviour
There are four main models of abnormal behaviour; biological; psychodynamic; cognitive behavioural; and the family systems model. The biological model postulates that abnormal behaviour is caused by biological factors and that psychological disorders are caused by disorders of the brain or nervous system, which can be physically treated. The psychodynamic model suggests that abnormal behaviour arise as a result of the unconscious conflict between the sexual and aggressive instincts of the Id, and the Superego’s representation of society’s ethical standards. The cognitive behavioural model assumes that psychological problems are distressing habits that are learned through the same processes as normal behaviour. Finally, the family systems model states that abnormal behaviours are maintained by the communicational style, and belief systems within the family and wider social systems.
Name one major achievement of each model
An important achievement of the biological model is that it led to the development of mental health legislation which makes provision for the involuntary detention and treatment of mentally ill people whose judgement is impaired. The psychodynamic model gave meaning to ‘meaningless behaviour’, showing how in phobias, for example, fears of one stimulus (e.g. one’s father) could be transferred onto other stimuli (e.g. horses). The cognitive behavioural model has led to the development of brief effective approaches to therapy which can now be applied to a wide range of patients. The family systems model shed light on the role of social context in the aetiology and treatment of psychological disorders, thus causing a paradigmatic shift in the field of psychology which previously focused solely on individualistic models of practice.
7. Psychotherapy Effectiveness
How effective is psychotherapy?
Psychotherapy is a treatment that has found to be effective in treating psychological problems in both children and adults. In a meta- analysis of 143 studies involving adult populations, it was found that adults who participated in the treatment had better outcomes than 84% of untreated patients, with an overall effect size of 1.03. The results of four broad meta analyses of studies involving children and adolescents revealed effect sizes ranging from .71 to .88, with a mean effect size of .77. This indicates that the average treated case fared better than 78% of control group cases. With an average of 2 out of 3 people benefiting from psychotherapy, it can be regarded as an effective treatment.
What are the main factors that account for the effectiveness of psychotherapy?
Despite the fact that there are different approaches to psychotherapy, common factors shared between them can account for much of the effectiveness of the treatment. Client factors can affect the results of the treatment as clients who are ready to change and show improvement early in treatment tend to respond better to psychotherapy. Other attributes include, high socio-economic status, social support, the capacity to make and maintain relationships, psychological-mindedness and ego strength. Therapist characteristics also play a role on the effectiveness of psychotherapy as well trained, technically competent, credible and those creative in their approach to helping clients solve problems tend to achieve higher success in patients. At least 20 sessions are required for most clients to recover. The therapeutic- alliance factor accounts for 38% of success as strong therapeutic alliances, with a therapist who is empathic and collaborative, and a client who is co-operative and committed to recovery achieving effective results. Therapists must also engage in specific forms of therapy for common factors to have a medium through which to operate.
8. Positive Psychology
What are the main causes and effects of happiness?
It has been proposed that there are three factors which determine levels of happiness; set- point; circumstances; and intentional activities. The happiness set point focuses on pre determined genetic factors as a cause of happiness such as personality traits and other individual differences. Circumstances, can also be considered to play a key role in causing happiness as it is said to account for around 10% of overall happiness. These circumstances, often environmental, include, relationships, work, religion, age, health and life events. It has been stated that 40% of our happiness is determined by our behaviour as intentional activities can be considered the key to happiness as the pursuing new outlooks, seeking new accomplishments and the control of thoughts and feelings can improve levels of happiness.
Many studies have revealed the beneficial effects of happiness. Happiness enhances health, whilst it does not cure illnesses it does protect against becoming ill as well as adding to one’s energy and vigour. There is also much evidence indicating that happiness has an important effect on longevity as positive psychological well- being is associated with reduced mortality. Barbara Fredrickson ‘Broaden and Build theory’ states that happiness broadens the way in which people think and act, offering opportunities for strengthening and developing personal resources, which in turn leads to personal growth and transformation. Thus, due to its cyclical nature, happiness, in turn causes more happiness. The positive emotion can also lead to better outcomes in areas such as work and relationships and also to greater positive perceptions of self and others, sociability, likability, co-operation, altruism, coping, conflict resolution, creativity and problem- solving.