Psychopathology

Past Paper Review

 16 MARK QUESTIONS
- ‘Behaviourists believe that all behaviour, both normal and abnormal, is learned through processes such as classical conditioning, operant
conditioning and social learning.’ Discuss the behavioural approach to explaining phobias.

- Discuss the cognitive approach to treating depression.

- Discuss biological explanations of obsessive-compulsive disorder (OCD). Refer to evidence in your answer.

- Rob is a sixth form student who has started hearing voices in his head. The voices come often, are usually threatening and make Rob feel
frightened. The voices are making it difficult for Rob to complete his homework properly and he is worried about how this may affect his
chances of going to university. Rob has not told anyone about his experiences, but his parents and teachers have noticed that he appears
distracted, anxious and untidy. Outline and evaluate failure to function adequately and deviation from ideal mental health as definitions of
abnormality. Refer to the experiences of Rob in your answer.
 ‘Behaviourists believe that all behaviour, both normal and abnormal, is learned
through processes such as classical conditioning, operant conditioning and social
learning.’ Discuss the behavioural approach to explaining phobias.

Your Answer

Plan:
• Gradually exposing the person to the thing that triggers their phobia, in a safe controlled
way
•

• Two-process model, explanation for disorders

• operant conditioning
• Strength: real world application
• Weak: Cognitive aspect of phobias not accounted
 ‘Behaviourists believe that all behaviour, both normal and abnormal, is learned
through processes such as classical conditioning, operant conditioning and social
learning.’ Discuss the behavioural approach to explaining phobias.

AO1 – 6 marks

Classical conditioning
- - Little Albert -> rat, loud noise

Operant conditioning
- - Positive and negative conditioning -> link between negative conditioning and phobias
 ‘Behaviourists believe that all behaviour, both normal and abnormal, is learned
through processes such as classical conditioning, operant conditioning and social
learning.’ Discuss the behavioural approach to explaining phobias.

AO3 – 10 marks

Evaluate Little Albert

- - Ecological validity
- - Lack of generalisability
Real-life application
- - Therapy
Incomplete explanation
- - Evolutionary factors
- - Not all phobias follow trauma
 ‘Behaviourists believe that all behaviour, both normal and abnormal, is learned
through processes such as classical conditioning, operant conditioning and social
learning.’ Discuss the behavioural approach to explaining phobias.

Example

Phobias can be explained using the behavioural approach. Classical conditioning was demonstrated in the Little Albert study , which
involved pairing a neutral stimulus (rat) with an unconditioned stimulus (noise) to elicit and unconditioned response (fear), after which the
rat became a conditioned stimulus leading to the conditioned response of fear without noise present. However, the study lacks ecological
validity as Little Albert was away from his normal environment, which could have affected his response. As a result, the findings of the study
cannot be generalised to the wider population. Operant conditioning involves pairing positive or negative reinforcement with behaviour to
encourage its repetition. Positive reinforcement involves receiving a desirable experience when performing a behaviour, such as a new
feeling of happiness when you walk into your house, which may reinforce staying at home and avoiding the outside, leading to the
development of a phobia. Negative reinforcement may encourage the development of phobias as the discomfort or anxiety an individual feels
may go away when they avoid the stimulus causing the anxiety, for example, walking away from a spider. This may reinforce avoidance
behaviours and condition the individual into developing a fear response to the stimulus, for example, arachnophobia. The behavioural
approach can be applied to real-life situations as it has led to the development of successful therapies to treat phobias, such as flooding and
systematic desensitization, which both use classical conditioning to replace feelings of fear with relaxation. However, the behavioural
approach is an incomplete explanation, as not all phobias follow trauma and are therefore not conditioned, which may be due to the
involvement of genetic or evolutionary factors influencing the development of phobias.
‘Behaviourists believe that all behaviour, both normal and abnormal, is learned
through processes such as classical conditioning, operant conditioning and social
learning.’ Discuss the behavioural approach to explaining phobias.

Mark Scheme
 Discuss the cognitive approach to treating depression.

Your Answer

CBT -
• identify irrationalities.
• test beliefs through experiments
• w: requires motivation/overemphasis on cognitions
• S: As effective as antidepressants
 Discuss the cognitive approach to treating depression.

AO1 – 6 marks

Beck’s cognitive behaviour therapy

- Negative Triad
- Patient as scientist
- Homework
- Reinforcement of positive thoughts
- Cognitive restructuring
Ellis’ rational emotive behaviour therapy
- ABCDE model
- Dispute
- Empirical and logical arguments
- Challenging automatic negative thoughts
- Behavioural activation
- Shame-attacking exercises
 Discuss the cognitive approach to treating depression.
Ao3- 10 marks

Supporting evidence
- March et al.
Therapy attempts to address root cause
Patient-therapist relationship
Commitment and motivation
Focus on current circumstances
Impact of social circumstances
Self-report
Antidepressants
 Discuss the cognitive approach to treating depression.

Example
Cognitive behavioural therapies (CBT) aim to modify negative schema and alleviate depression. Beck’s cognitive therapy involves
the identification of negative triad thoughts before the patient generates hypotheses to test the validity of their irrational thoughts.
Therapists can set homework foe their patients to investigate their irrational thoughts and might reinforce positive thinking in their
practice. Following these steps of CBT can lead to cognitive restructuring which may alleviate symptoms of depression. March et al
found that CBT was as effective as antidepressants in treating depression, with 81% of patients in both the CBT and antidepressant
conditions showing significant improvement in symptoms of depression. Moreover, March et al showed that combining CBT with
antidepressant treatment is more effective at treating depression, with 86% of participants showing significant improvement. Ellis’
rational emotive behaviour therapy (REBT) involves the ABCDE model, in which the ABC three-stage model of CBT (acting event,
beliefs, and consequences) is joined with D (dispute) and E (effect). This involves the therapist disputing the patient’s automatic
negative thoughts using logical or empirical arguments. Whilst the cognitive approach has led to the development of therapies,
which aim to address the root cause of depression, they assume that the cause is irrational thoughts, ignoring the influence of past
trauma and social circumstances. Focussing too much on a patient’s current cognition prevents them from being able to address
issues from the past or changing their circumstances for the better. Moreover, CBT requires patients to be motivated and committed
to the process, which may be difficult for patients with severe depression, and may be less effective than initial antidepressant
treatment. Additionally, the success of therapy may be tied to the quality of the patient-therapist rapport and the accuracy of the
patient’s self-reported symptoms.
Discuss the cognitive approach to treating depression.

Mark Scheme
 Discuss biological explanations of obsessive-compulsive disorder (OCD). Refer to
evidence in your answer.
Your answer:

certain genes leave likelihood of mental disorders

imbalances in neurotransmitters such as serotonin, dopamine and glutamine
shared environments
 Discuss biological explanations of obsessive-compulsive disorder (OCD). Refer to
evidence in your answer.
AO1 - 6 marks
Genetic and Biochemical explanations
- Genetic predisposition
- Polygenic condition
- COMT gene
- Production of catechol-O-methyltransferase
- Regulates dopamine
- One COMT variation leads to excessive dopamine production
- Compulsive/repetitive behaviour
- SERT gene
- Mood regulation
- May cause decreased serotonin production
- Anxiety
Physiological explanation
- Basal ganglia responsible for psychomotor function
- Hypersensitivity may lead to repeated movements
- Abnormality in orbital frontal cortex
 Discuss biological explanations of obsessive-compulsive disorder (OCD). Refer to
evidence in your answer.
AO3 - 10 marks
COMT gene
- Taylor
- 230 genes may be involved in OCD
- Variations may be implicated in subtypes of OCD
- Epigenetics
- Gene variation -> OCD? OR OCD -> gene variation?
Family studies
- Lewis
- 37% of OCD patients had parents with OCD
- 21% of OCD patients had siblings with OCD
- Nestadt et al.
- Individuals with first-degree relative with OCD 5x more likely to develop OCD
- Don’t rule out other factors influencing OCD development, including shared environments
SERT gene
- Piggott et al.
- Drugs increasing serotonin in synapse were effective in treating patients with OCD
- Not all patients respond to drug treatments
Basal Ganglia
 Discuss biological explanations of obsessive-compulsive disorder (OCD). Refer to
evidence in your answer.
Example
Individuals can be genetically predisposed for developing OCD, which is a polygenic condition. The COMT gene produces
catechol-O-methyltransferase and regulates dopamine production. Variation in the COMT gene may lead to excessive
dopamine production, which is linked to compulsive behaviour. This is supported by Taylor who suggested OCD may be
linked to 230 genes, in which genetic variations may be linked to OCD subtypes. However, epigenetics makes it unclear
whether genetic variation causes OCD or whether OCD leads to genetic variation. Family studies have shown that 37% of
OCD patients have parents with OCD and 21% have siblings with OCD (Lewis). Nestadt et al have suggested that
individuals with a first-degree relative with OCD are five times more likely to develop OCD in their lifetime. However,
family studies don’t rule out the influence of other factors on OCD development, such as shared environments. The SERT
gene is involved with serotonin production, which regulates mood and may be involved in OCD development. Individuals
with low levels of serotonin may be more anxious, which may be related to the severity of OCD symptoms. The role of
serotonin in OCD is supported by Piggott et al who found that SSRIs increasing the amount of serotonin in the synapse were
effective in treating OCD patients. However, not all patients respond to drug treatments, so the biochemical theory is not a
complete explanation of OCD. Additionally, the basal ganglia has been implicated in psychomotor function and
hypersensitivity in this structure can lead to repetitive movements. OCD has also been linked to abnormality in the orbital
frontal cortex. However, whilst physiological explanations address causes of repetitive behaviour, they do not explain the
cause of obsessive thoughts and cannot completely explain OCD.
Discuss biological explanations of obsessive-compulsive disorder (OCD). Refer to
evidence in your answer.
Mark Scheme
 Rob is a sixth form student who has started hearing voices in his head. The voices
come often, are usually threatening and make Rob feel frightened. The voices are
making it difficult for Rob to complete his homework properly and he is worried
about how this may affect his chances of going to university. Rob has not told anyone
about his experiences, but his parents and teachers have noticed that he appears
distracted, anxious and untidy. Outline and evaluate failure to function adequately and
deviation from ideal mental health as definitions of abnormality. Refer to the
experiences of Rob in your answer.
Your answer

failure to function adequately

S: Identify differences
W: Might be different, might be functioning fine - we might not be functioning adequately
Deviation from ideal mental health
S: Identify mental health issues
W: Might not have any mental health issues
 Outline and evaluate failure to function adequately and deviation from ideal mental
health as definitions of abnormality. Refer to the experiences of Rob in your answer.
AO1 – 6 marks
Failure to function adequately (FFA)
- Demands of everyday living
- Maladaptive, irrational, and/or dangerous behaviour
- Distress (personal and to others)
Deviation from ideal mental health
- Abnormality defined by absence of ideal charactersitics
- Jahoda’s criteria
- Accurate perception of reality
- Self-actualization
- Resistance to stress
- Self-esteem
- Independence
- Adapted to environment
- Fewer criteria met -> higher abnormality
Outline and evaluate failure to function adequately and deviation from ideal mental
health as definitions of abnormality. Refer to the experiences of Rob in your answer.
AO2 – 4 marks

FFA
- Rob is not coping with everyday tasks
- cannot complete homework
- untidy
- Rob is causing distress to parents and teachers
- Personal distress (anxiety and fear)
Deviation from ideal mental health
- Rob’s perception of reality is not accurate (hearing voices)
- Voices preventing Rob from self-actualizing (may affect chances of going to university)
Outline and evaluate failure to function adequately and deviation from ideal mental
health as definitions of abnormality. Refer to the experiences of Rob in your answer.
AO3 – 6 marks

FFA
- Recognises patient’s perspective
- Distressed/distressing judgement is subjective
- Not all abnormal behaviour is associated with distress/failure to cope
- Not all maladaptive behaviour indicates mental illness
Deviation from ideal mental health
- Positive and holistic approach
- Criteria are unrealistic
- Culture bias (independence)
- Overlap with deviation from social norms and statistical infrequency
 Outline and evaluate failure to function adequately and deviation from ideal mental
health as definitions of abnormality. Refer to the experiences of Rob in your answer.
Example
Failure to function adequately (FFA) defines abnormality as an inability to cope with the everyday demands of life; maladaptive, irrational, or
dangerous behaviour; the experience of personal distress or the cause of distress to others. Rob demonstrates difficulty coping with everyday tasks,
such as completing his homework and keeping tidy, and he is causing his teachers and parents to feel distressed. Rob is also experiencing personal
distress in the form of anxiety and fear, as a result, Rob would be considered abnormal according to FFA. A strength of FFA is that it considers
individual’s experiences and perspectives, which may encourage individuals to seek mental health support earlier than they otherwise would have, due
to the misconception that one needs to be ‘unwell enough’ before getting help. However, the judgement of whether a person is causing distress to
themselves or others is subjective and may differ between individuals. Furthermore, not all abnormality is linked to distress or a failure to cope, as in
psychopathy, and not all maladaptive behaviour is caused by mental illness and should not be treated as such. For example, unemployment could be
considered by some to be a failure to function adequately, though it may be a lifestyle choice for others living ‘off-grid’ or raising children. Deviation
from ideal mental health involves defining abnormality by the absence of ideal characteristics, where abnormality is higher when few criteria are met.
Jahoda developed the following criteria: accurate perception of reality; self-actualization; resistance to stress, good self-esteem; independence;
environmental adaptation. Rob has been hearing voices, showing that his perception of reality is not accurate, which may prevent him from self-
actualizing as it may affect his chances of going to university. According to these criteria, Rob would be considered abnormal. Deviation from ideal
mental health promotes a positive and holistic approach to defining abnormality, though the proposed criteria may be unrealistic to maintain
consistently. Moreover, the criteria may have a western bias, for example, the criteria of independence and self-actualization may not be relevant to
collectivist cultures where community is encouraged. This approach also has overlap with other definitions of abnormality, such as deviation from
social norms, in that socially expected perceptions of reality may be different depending on the culture. Nevertheless, this approach is very detailed
and considers most reasons for which individuals seek professional help.
Outline and evaluate failure to function adequately and deviation from ideal mental
health as definitions of abnormality. Refer to the experiences of Rob in your answer.
Example
Moving on to the rest of the paper

2 markers
4 markers
6 markers
8 markers
12 markers
Q1.
Main techniques are firstly, teach deep muscle or progressive relaxation. Then the therapist and client construct an anxiety
hierarchy, starting with situations that cause a small amount of fear – in Hamish’s case this might be standing on a small
stepladder – then listing situations that cause more fear, with the most frightening situation being at the top of the hierarchy, such
as standing on top of a mountain. Finally, they work through this list, with the client remaining relaxed at each stage. The two
main features are relaxation and working through the anxiety hierarchy.

Q3.
a) Obsessions: recurrent thoughts; Compulsions: repetitive behaviours that reduce anxiety.
b) Repeated measures design means that the same participants are used in both conditions of the study. This means that the
children whose anxiety ratings are taken in the ‘before therapy’ condition are the same children as those who provide the anxiety
ratings for the ‘after therapy’ condition.
c) The advantage of repeated measures design is that there will be no participant variables so any differences in performance
(the median anxiety ratings before and after therapy) are more likely to be due to the manipulated variables than other variables,
so the validity of the results is increased.
Q4.
- improvements in psychological treatment programmes which may mean that people manage their health better and take less
time off work. This would reduce costs to the economy
- better ways of managing people who are prone to mental health issues whilst they are at work which could improve their
individual productivity, again boosting the economy overall
- ‘cutting-edge’ scientific research findings into treatments for mental health issues carried out in UK may encourage investment
from overseas companies into this country which could boost the economy
- providing effective treatments might be a significant financial burden to an NHS service already under huge financial strain
- discovering that new treatments may be more effective than older therapies and that these may be more expensive so could
increase the financial burden to the economy.

Q5.
Elkin comparison of therapies for depression using four conditions; Robinson meta-analysis of different therapies for depression;
Hollon comparison of cognitive and drug treatment for depression.
March et al. comparison of effectiveness of CBT (81%), antidepressants (81%), and CBT with antidepressants (86%) in
improving symptoms of depression.
Q6.
A – self; B – future

Q9.
- immediate exposure
- prevention of avoidance
- until they are calm/anxiety has receded/fear is extinguished

Q10.
a) phobias can be learned through classical conditioning, where fear is acquired when a neutral stimulus becomes associated
with a frightening event.
b) not all phobias are triggered by a traumatic experience, where the initial association between the phobic object and fear is
formed, suggesting that alternative explanations are needed.

Q11.
One weakness of SD is that it relies on the client’s ability to imagine the fearful situation. Some people cannot create a vivid
image and thus SD is not effective.
Q12.
- Tommy would be taught relaxation techniques he could use when he encounters birds as part of the therapy.
- Tommy would devise his hierarchy so it reflects his least to most feared bird situation (for example, small picture of a
sparrow, then a small bird through a window...).
- Tommy would then be exposed to birds gradually, ensuring he is relaxed at each stage.
- SD is gradual so the anxiety produced in the treatment is limited whereas in flooding the most feared situation is presented
immediately which would be too traumatic for a small child.
- Tommy may not fully understand that consent to flooding would mean immediate exposure to his most feared situation so his
consent to SD increases his protection from harm.

Q13.
- Kirsty’s phobia has developed through classical conditioning – she has formed an association between the neutral stimulus
(balloon) and the response of fear
- the conditioned response is triggered every time she sees a balloon (or hears similar noises)
- her phobia has generalised to situations where balloons might be present, such as parties and weddings, and to similar noises,
‘banging’ and ‘popping’
- her phobia is maintained through operant conditioning – the relief she feels when avoiding balloons becomes reinforcing.
Q14.
- Behavioural characteristic – this is the compulsion element of the disorder, where a behaviour is performed repeatedly to
alleviate anxiety
- Cognitive characteristic – this is the obsessive element of the disorder, where the sufferer experiences unwanted/intrusive
thoughts or images that cause distress

Q15.
- physiological, behavioural, emotional and cognitive signs / symptoms: avoidance of phobic stimulus, feelings of fear when
exposed to phobic stimulus, may experience heart palpitations and sweating from anxiety.
- course and prognosis: phobias can be treated through flooding, where they are exposed to their most fearful phobic situation
immediately and until they are relaxed, or systemic desensitisation, where they are exposed to the least fearful phobic
situation to the most, whilst remaining relaxed at each stage.

Q16.
- Depression is characterised by low mood and feelings of sadness/hopelessness. Individuals may experience under/over-
sleeping and eating. Individuals may experience negative thoughts regarding themselves, the world, and their future.
Depression can be treated with cognitive behaviour therapy, such as Beck’s cognitive therapy and Ellis’ ABCDE model, which
target irrational thought to alleviate symptoms of depression. Antidepressants can also be used to treat depression, either on
Q17.
a) Obsessions – repetitive thoughts causing distress; Bob is experiencing fearful thoughts that his family could be endangered
if he does not complete his checking routine. Compulsions - repetitive behaviours alleviating anxiety; Bob is repeatedly
checking that doors are locked and plug sockets are switched off, which is time consuming.
b) Neural explanations (neurochemical and neurophysiological) – Bob is having a scan.
- The basal ganglia and other circuits have been implicated suggesting that disturbed communication in these structures might
account for the repetitive behaviours seen in Bob’s OCD. Also, OCD linked to excessive activity in the orbital frontal cortex
– related to the regulation of unpleasant emotions.
- Low levels of serotonin - serotonin might be removed too quickly before impulses have passed.
Genetic explanations – Bob’s family history is being looked at
- Focus on the search for gene markers that Bob might have inherited – COMT and SERT.
- Family studies indicate a higher percentage of first-degree relatives, ie Bob’s parents, have this disorder – 10% compared to
the prevalence rate of 2%.

Q18.
A - cognitive
Q19.
Failure to function adequately (FFA) refers to abnormality that prevent the person from carrying out the range of
behaviours that society would expect from them, such as getting out of bed each day, holding down a job etc. Rosenhan &
Seligman suggested a range of criteria that are typical of FFA. These include observer discomfort, unpredictability, and
irrationality, among others. Cultural relativism – what is considered adequate in one culture might not be so in another. 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. 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.

Q20.
- Difficulty of meeting all criteria, very few people would be able to do so, and this suggests that very few people are
psychologically healthy.
- The criteria are subjective and not operationalised, so being defined as abnormal is not objective.
- These ideas are culture-bound, based on a Western idea of ideal mental health: cultural relativism.
Q21.
One limitation of the deviation of social norms definition is that norms can vary over time. This means that behaviour that
would have been defined as abnormal in one era is no longer defined as abnormal in another.
With failure to function adequately, there is a cultural limitation in that the definition does not take account that ‘adequate’
behaviour varies from one culture to another.
The main limitation with ideal mental health is that the criteria are so demanding that very few people will be able to meet
all the criteria.

Q22.
statistical infrequency - the doctor says depression is quite common therefore Bina’s behaviour should not be considered
abnormal.
failure to function adequately – Bina is neglecting personal hygiene she also takes lots of time off work therefore her
behaviour could be considered abnormal.
deviation from ideal mental health - Bina is miserable therefore her behaviour could be considered abnormal.
deviation from social norms – Bina has temper tantrums/is rude to customers which is not the norm for adults in a work
environment therefore her behaviour could be considered abnormal.
Q23.
One limitation of the deviation from social norms definition is that social norms change with time; this is illustrated by the
changing views on homosexuality. With the deviation from ideal mental health, there is the problem of cross-cultural
variations. A further problem is that the ideals are so demanding that almost everyone would be considered abnormal to
some degree. The ‘failure to function adequately’ definition has the advantage of a more objective measuring scale (eg the
GAF). However, it can be criticised as not differentiating sufficiently between abnormal behaviour and unconventional or
eccentric behaviour.

Q25.
- attempt to increase or decrease levels of neurotransmitters or the activity of neurotransmitters in the brain
- general purpose is to decrease anxiety, lower arousal, lower blood pressure or heart rate
- antidepressants – SSRIs – prevent the reuptake of serotonin and prolong its activity in the synapse in order to reduce
anxiety / normalise the ‘worry circuit’
- tricyclics – block the transporter mechanism that re-absorbs both serotonin and noradrenaline, again prolonging their
activity
- anti-anxiety drugs – such as benzodiazepines – enhance the activity of GABA and therefore slow down the CNS causing
relaxation
- SNRIs – more recent drugs which also increase levels of serotonin and nor-adrenaline and are tolerated by those for whom
Q27.
- results indicate development of OCD is at least partly genetic
- the findings suggest that heritability is high (between 45% and 65%)
- this means that there must also be other explanations (inherited influence is not 100%)
- so other factors (eg environment or other bio factors) may also partly account for OCD.

Q28.
- A cognitive characteristic would be an irrational belief or persistent recurring thoughts – catastrophic thinking such as: ‘my
family is in danger and might get trapped in a house fire’.
- An emotional characteristic would be feeling anxiety or relief from anxiety such as: ‘worry about them’ or ‘feeling calm after
making sure a fire cannot start’.
- A behavioural characteristic would be performing a repetitive action such as: switching plug sockets six times.

Q29.
- The two averages are very similar, suggesting that both therapies are as good as each other.
- The range of each group is very different. This suggests that for some people Therapy A was very beneficial, but for others
it had little benefit. For Therapy B, there was a much smaller range, suggesting that it has a similar effect on improvement
for all the patients.