Definitions Of Abnormality

Statistical Infrequency

AO1

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 who has 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 the presence of 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.
AO3

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

AO1

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?

AO3

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

AO1

Failure to function adequately (FFA) refers to an abnormality that prevents

the person from carrying out the range of behaviors that society would
expect from them, 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.

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.

AO3

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

AO1

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.

 Accurate perception of reality: Having an objective and realistic view of

the world.

AO3

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 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
AO1

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.

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)

AO3

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

AO1

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 2–3%) is
the baseline against which the concordance rates can be compared.

The SERT gene (Serotonin Transporter) appears to be 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.

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.

AO3

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
because of genetic factors.

Neural Explanations

AO1

Neural mechanisms refer to regions of the brain, 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.

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.

AO3
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 disorders. Thus, these biochemical
abnormalities are not specific to OCD and may be true of any form 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.

AO3

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 seem to 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.

Cognitive Approach To
Depression
Characteristics of Depression

AO1

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 that 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.

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

marks)

Beck’s Negative Triad

AO1

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.

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.

AO3

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

AO1

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.

AO3

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

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.

AO3
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.

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 thinking 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
AO1

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.

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

AO1

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.

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.

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 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
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

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.

The success of the method 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.