MENTAL DISORDERS

Phobias, Depression and OCD

Yasmine Khalfi
 WHAT IS A
MENTAL
DISORDER??

A mental disorder is a behavioral or mental

pattern that causes significant distress or
impairment of personal functioning. Many
disorders have been described, with signs and
symptoms that vary widely between specific
disorders.
Mental disorders are usually defined by a
combination of how a person behaves, feels,
perceives, or thinks. This may be associated
with particular regions or functions of the brain,
often in a social context.
Psychotherapy and psychiatric meditation are
two major treatment options. Other treatments
include lifestyle changes, social
interventions, peer support, and self-help.
PHOBIAS
All phobias are characterized by
excessive fear and anxiety, triggered by
an object, place or situation. The latest
version of the DSM recognizes the
following categories of phobias and
related anxiety disorder:
• Specific phobia – phobia of an object,
such as an animal or body part, or a
situation such as flying or having an
injection
• Social anxiety (social phobia) – phobia
of a social situation such as public
speaking or using a public toilet
• Agoraphobia – phobia of being
outside or in a public place
 PANIC AVOIDANCE

BEHAVIOURAL
CHARACTERISTICS ENDURANCE
OF PHOBIAS
 • The acquisition of phobias is seen to occur through classical conditioning, such
as the experience of a traumatic event which then gives rise to fear (or phobia)
from it happening in the future
• The maintenance of phobias is seen as occurring through operant conditioning,
where avoiding a fear situation acts as a negative reinforcer – whenever we avoid a
THE BEHAVIORAL phobic stimulus and we successfully escape it our fear is reduced, the avoidance
behavior is reinforced, and the phobia is maintained
APPROACH TO
EXPLAINING
PHOBIAS

THE TWO-
PROCESS MODEL

Mowrer (1960)
 EVALUATION OF THE
TWO-PROCESS MODEL

• Has important implications of therapy- if a patient is

prevented from practicing their avoidance behavior, phobic
behavior declines; it identifies a means of treating phobias
making it more valid
• Does not account for the cognitive aspects of phobias-
phobias have a significant cognitive component (e.g. irrational
beliefs such as thinking that a spider is dangerous); the model
does not provide adequate explanation for phobic cognitions and
therefore symptoms of phobias
• Provides a link about how traumatic experiences can lead to
trauma- Jongh et al. (2006) traumatic experience involving
dentistry; association between stimulus and UCR leads to the
development of the phobia
• Not all traumatic experiences lead to a phobia- limits the
validity of the link the two-process model provides
 THE BEHAVIORAL APPROACH
TO TREATING PHOBIAS

SYSTEMATIC DESENSITISATION
Classical conditioning, if a person can learn to relax in the presence of the
phobic stimulus, they will be cured.
Three processes involved in SD
1. An anxiety hierarchy is put together by a client
and the therapist 2. Relaxation- reciprocal inhibition, can’t be afraid
and relaxed at the same time so the client relaxes as much as possible
3. Exposure- the patient works their way up the fear
hierarchy, starting at the least unpleasant stimuli and practicing their
relaxation technique as they go

FLOODING
Extinction- a learned response is extinguished when the CS (dog) is
encountered without the UCS (being bitten). The result is that the CS no
longer produces the CR (fear).
 EVALUATION OF SD

• Evidence for its effectiveness- Gilroy et al. (2003) used 42 people with
arachnophobia in 3, 45-minute sessions, they were less fearful afterwards, SD is
likely to be helpful

• It’s used to treat people with learning disabilities- because it is not a

cognitive process and doesn’t cause the amount of distress flooding does, SD is
considered the most appropriate treatment

• Some may use VR in the process of SD- it can be less dangerous in situations
such as phobia of heights however, it may be considered less effective due to
lack of realism
 EVALUATION OF
FLOODING

• Cost-effective- flooding can work in as little as one session, as opposed to10

sessions for SD, more people can be treated at the same cost with flooding
rather than SD

• It’s a traumatic experience- Schumacher et al. (2015) found that participants

and therapists rated flooding as significantly stressful which leads to high
attrition (dropout) rates, therapists must obtain informed consent to avoid
the rise of ethical issues, this suggests that therapists may avoid flooding

• Not effective for more complex phobias- by only focusing on the removal
of symptoms (as the behavioral therapists do) rather than in identifying the
underlying cause (as cognitive therapists do), a disorder may only be removed
temporarily and may reoccur later or be substituted by a different one
 UNREASONABLE EMOTIONAL
RESPONSE

FEAR ANXIETY

e.g., a person with arachnophobia will have a strong

emotional response to a tiny spider

EMOTIONAL CHARACTERISTICS OF
PHOBIAS
 COGNITIVE CHARACTERISTICS OF
PHOBIAS

• Selective attention to the phobic stimulus: if a person can see the phobic
stimulus it is hard to look away from it (e.g., a person with pogonophobia will
struggle to concentrate on what they are doing if there is someone with a beard
in the room)
• Irrational beliefs: a person with a phobia may hold unfounded thoughts in
relation to phobic stimuli (e.g., a person with arachnophobia may believe that
all spiders are dangerous and deadly, despite the fact that no spiders in the UK
are actually deadly)
• Cognitive distortions: the perceptions of a person with a phobia may be
inaccurate and unrealistic (e.g., a mycophobic sees mushrooms as disgusting)
DEPRESSION
All forms of depression and depressive disorders are
characterized by changes to mood. The latest version of
the DSM recognizes the following categories:
• Major depressive disorder – severe but often short-
term depression
• Persistent depressive disorder – long-term or
recurring depression, including sustained major
depression
• Disruptive mood dysregulation disorder –
childhood temper tantrums
• Premenstrual dysphoric disorder – disruption to
mood prior to and/or during menstruation
 LOW ACTIVITY LEVELS

BEHAVIORAL
CHARACTERISTICS AGGRESSION AND SELF-HARM

OF DEPRESSION DISRUPTION TO SLEEP AND EATING BEHAVIOR

 LOWERED SELF-ESTEEM LOWERED MOOD

EMOTIONAL
CHARACTERISTICS
ANGER
OF DEPRESSION
 COGNITIVE
CHARACTERISTICS OF
DEPRESSION

• Poor concentration – the person may find themselves unable

to stick with a task as they usually would, or find it hard to
make decisions that they would normally find straightforward
• Attending to and dwelling on the negative – when
experiencing a depressive episode people pay attention to
negative aspects of a situation and ignore the positives
• Absolutist thinking – when a situation is unfortunate,
depressed people tend to see it as an absolute disaster
 THE COGNITIVE APPROACH
TO EXPLAINING DEPRESSION

Beck’s negative triad

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 while also attending only to the
negative aspects of a situation rather than the positives.

Cognitive vulnerability

Ellis’s ABC model

Example:
A=  you pass a friend in the corridor at school, and he/she ignores you, despite
the fact you said ‘hello’
B=an irrational interpretation of the event might be that you think your friend
dislikes you and never wants to talk to you again
C= I will ignore my friend and delete their mobile number, as they clearly
don’t want to talk to me
 EVALUATION OF THE COGNITIVE
APPROACH TO EXPLAINING DEPRESSION

Beck’s negative triad

• It has good supporting evidence– Grazioli and Terry (2000) assessed 65 pregnant women for cognitive
vulnerability and depression before and after birth. They found that those women with high cognitive
vulnerability were most likely to suffer from post- natal depression, suggesting that there is an association
between cognitive vulnerability and depression
• It has a practical application in CBT– the idea behind CBT is to identify automatic thoughts about the
world, self and future; this is the negative triad. Once identified, the thoughts shall be challenged. This shows
that understanding of cognitive vulnerability is useful in aspects of clinical practice
• It doesn’t explain all aspects of depression – depression is complex, some depressed patients experience
hallucinations and bizarre beliefs. Beck’s cognitive theory does not explain the emotional aspect of
depression
 EVALUATION OF THE COGNITIVE
APPROACH TO EXPLAINING DEPRESSION

Ellis’s ABC model

• Real-world application to therapy- used to develop effective treatments for depression, including CBT
and REBT, which attempt to identify and challenge negative, irrational thoughts and have been
successfully used to treat people with depression. This provides further support to the cognitive
explanation of depression.
• Partial explanation- Ellis’s model only explains how we respond to life-activating events (reactive
depression) and not how we respond to cases of depression that are non-traceable to life events
(endogenous depression).
• Ethical issues- it locates responsibility for depression purely with the depressed person. Critics find it
unfair to blame the depressed person.
THE COGNITIVE APPROACH TO
TREATING DEPRESSION
 COGNITIVE BEHAVIOR
THERAPY

• Cognitive therapy aims to help clients test the

reality of negative beliefs by recording positive
events that happened and then using them to
challenge their negative/irrational beliefs.
• A REBT therapist identifies the client’s irrational
thoughts and then challenges them by either an
empirical argument (is there actual evidence of that
belief?) or a logical argument (does the negative
thought logically follow the facts?).
• Behavioral activation- gradually decreasing
avoidance and isolation by doing activities that have
shown to improve mood.
 EVALUATION OF THE COGNITIVE
APPROACH TO TREATING DEPRESSION
• Evidence for effectiveness- March et al. (2007), CBT was just as effective as
antidepressants and even more so when used along with antidepressants. It’s
also
Cost effective- a brief therapy requiring 6 to 12 sessions only,
therefore CBT is widely seen as the first of treatments in public health
treatment (e.g., NHS)

• Limited suitability for diverse clients- some clients are too distressed to
engage to CBT, Sturmey (2005) suggests that any form of psychotherapy that
includes talking, and overall cognitive procedures is not suitable for clients
with learning disabilities
• counterevidence-
Lewis& Lewis (2016) conducted that CPT was as effective as other treatments
for severe depression, suggesting that it may be suitable for a wider range of
people than once thought

• Limited last of CBT’s effects- Ali et al. (2017) found that 42% of the
participants relapsed into depression within 6 months, this suggests that CBT
may need to be repeated periodically
OBSESSIVE-COMPULSIVE
DISORDER
The DSM system recognizes OCD and a range of related disorders:
• OCD – characterized by either obsessions (recurring thoughts, images, etc.)
and/or compulsions (repetitive behaviors such as hand-washing). Most people
with diagnosis of OCD have both obsessions and compulsions.
• Trichotillomania – compulsive hair-pulling
• Hoarding disorder – the compulsive gathering of possessions and the inability
to part with anything, regardless of its value
• Excoriation disorder – compulsive skin-picking
 COMPULSIONS REDUCE ANXIETY

AVOIDANCE
BEHAVIORAL
CHARACTERISTICS OF
OCD
e.g., people who wash their hands compulsively may
avoid coming into contact with germs

COMPULSIONS ARE REPETITIVE

 ACCOMPANYING DEPRESSION

GUILT AND DISGUST ANXIETY AND DISTRESS

EMOTIONAL CHARACTERISTICS
OF OCD
 COGNITIVE CHARACTERISTICS OF
OCD

• Obsessive thoughts – e.g., worries of being contaminated by dirt and germs, or

certainty that a door has been left unlocked and that intruders will enter
through it
• Cognitive coping strategies – this may help manage anxiety but can make the
person appear abnormal to others and can distract them from everyday tasks
(e.g., a religious person tormented by guilt may respond by praying/meditating)
• Insight into excessive anxiety – people with OCD experience catastrophic
thoughts about the worst-case scenarios that might result if their anxieties were
justified.
 THE BI OLOGICAL APPROACH TO EXPLAINI NG OCD-
GENETIC EXPLANATIONS

• Lewis (1936) 37% of his participants had parents with OCD and 21% had
siblings with OCD, suggesting that OCD runs in families
• Candidate genes create vulnerability for OCD, some of them are involved in
regulating the development of the serotonin system
• OCD is polygenic- Taylor (2013) found that up to 230 genes may be involved
with OCD, genes that have been studied in relation to OCD include those
associated with the action of dopamine
• OCD is aetiologically heterogenous- one group of genes may cause OCD in
one person, but a different group of genes may cause the disorder in another
person
 EVALUATION OF GENETIC
EXPLANATIONS

• Supporting evidence- Nestadt et al (2010) showed that 68% of

identical twins were both diagnosed with OCD, compared to 31% of
non-identical twins, Marini and Stebnicki (2012) found that a person
who has a family member with OCD is 4 times more likely to develop
OCD than one who doesn’t, suggesting that there is a genetic basis

• Environmental risk factors- Cromer et al. (2007) found that OCD

was more severe in patients who had experienced traumatic events in
their lives, and even more severe where patients had experienced
more than one event, this shows that that genetic vulnerability only
provides partial explanation for OCD
 THE BIOLOGICAL APPROACH
TO E X P L AI N A I NG O C D -
N E U R A L E X P L AN AT I O N S

• The role of serotonin- if a person has low levels of

serotonin then normal transmission of mood-relevant
information does not take place and a person may
experience low moods.

• Decision-making systems- abnormal functioning of the

frontal lobes of the brain (responsible for logical
thinking& making decisions) and abnormal functioning of
the parahippocampal gyrus (responsible for processing
unpleasant emotions) are said to be associated with OCD.
 EVALUATION
OF NEURAL
EXPLANATION

• Supporting evidence from antidepressant

studies shows that increasing serotonin
levels reduces OCD symptoms, suggesting
serotonin has a role in the development of
OCD

• No unique neural system- many people

who experience OCD also experience
clinical depression which probably
involves disruption to the action of
serotonin. This means that serotonin may
not be relevant to OCD symptoms and that
it’s rather depression the causes such
disruption.
THE BIO LO GIC AL APPRO ACH TO
TREATIN G O CD
Drug therapy
 SELEC TIVE
SERO TO N IN
REUPTAKE
IN HIBITO R (SSRIS)

SSRIs are a class of drugs that

are typically used
as antidepressants in the
treatment of major depressive
disorders, anxiety disorders, and
related illnesses to serotonin
deficiencies, such as OCD
(obsessive compulsive disorder).
SSRIs work on the serotonin
system in the brain.
 HO W DO ES IT
W O RK?

Se rotonin is released by the

presynaptic neurons and travels
across a synapse .
The neurotransmitter chemically
conveys the signal from the
presynaptic ne uron to the
postsynaptic neuron where it is
broken down and reused.
By preventing the reabsorption
and breakdown, SSRIs effectively
incre ase leve ls of serotonin in
the synapse and thus compensate
for whatever is wrong with the
serotonin system in OCD.
 EVALUATIVE PO IN TS

1. There is evidence of effectiveness- Soomro et al. (2009), reviewed studies that compared
SSRIs to placebos, he estimated that 70% of patients benefit from drug treatments drugs
appear to be helpful for most people with OCD
2. Drug treatments are much more cost-e ffe ctive in comparison to sessions of a psychological
therapy ( thousands of tablets can be manufactured in the time of one therapy session)
3. All the drugs used to treat depression have adve rse re actions; these could include weight
gain, nausea, blurred vision and loss of sex drive.These side-effects are usually temporary;
however, they can be quite distressing for people and for a minority they are long lasting.
4. SSRIs are non-disruptive to people’s lives- one can simply take drugs until their symptoms
decline, that’s not possible in therapy where time spent attending sessions is involved