Clinical Psychology and Mental Health — AQA A-Level Psychology
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Clinical Psychology and Mental Health explained
In Psychopathology, defining abnormality involves four main approaches.
Read the full explanation
Statistical infrequency defines abnormality as mathematically rare behaviours, like an IQ < 70. Deviation from social norms views abnormality as violating unwritten societal rules, e.g., antisocial personality disorder. Failure to function adequately is when one cannot cope with everyday life, showing distress (e.g., severe depression preventing work). Jahoda’s deviation from ideal mental health identifies abnormality by the absence of positive traits, like self-actualisation. Each definition has limitations, such as cultural bias or subjective distress assessment.
The behavioural, emotional and cognitive characteristics of phobias, depression and obsessive-compulsive disorder (OCD).
Diagnosis works in three columns: what the person does, what they feel, what they think. Phobias show avoidance, endurance and panic such as freezing or fainting; anxiety out of all proportion to the danger; and selective attention to the phobic stimulus with irrational beliefs about it. Depression shows raised or reduced activity, disrupted sleep and appetite, sometimes self-harm; lowered mood, anger and lowered self-esteem; and poor concentration, dwelling on the negative and absolutist black-and-white thinking. OCD shows compulsions that are repetitive and performed to reduce anxiety, with avoidance; anxiety, guilt and disgust; and obsessive intrusive thoughts with insight that the fear is excessive. Examiners credit the right item in the right column, so label each one as you write it.
The behavioural approach to explaining and treating phobias: the two-process model, including classical and operant conditioning; systematic desensitisation, including relaxation and use of hierarchy; flooding.
Mowrer's two-process model says a phobia is learned twice. Classical conditioning acquires it: Watson and Rayner paired a white rat (neutral stimulus) with a loud noise until Little Albert cried at the rat alone. Operant conditioning maintains it: avoiding the feared object removes anxiety, and that relief is negative reinforcement. Systematic desensitisation counter-conditions it with relaxation training, an anxiety hierarchy and gradual exposure, since fear and relaxation cannot be felt together. Flooding uses immediate full exposure until adrenaline falls and fear extinguishes. Evaluate with Gilroy: 42 spider phobics given SD were less fearful at 33 months, while flooding is cheaper but traumatic with high refusal rates.
The cognitive approach to explaining and treating depression: Beck’s negative triad and Ellis’s ABC model; cognitive behaviour therapy (CBT), including challenging irrational thoughts.
Beck traces depression to a negative self-schema formed in childhood, which produces faulty processing such as overgeneralisation, and settles into the negative triad: a pessimistic view of the self, of the world and of the future, each feeding the next. Ellis writes it as ABC, where an Activating event meets a Belief and the Consequence follows from the belief rather than the event, so a demand such as I must succeed at everything produces the depression. CBT tests those beliefs: the client records automatic thoughts, the therapist disputes them empirically by asking for the evidence and logically by asking whether the conclusion follows, and homework sets behavioural experiments. March found 81% of adolescents improved on CBT, matching antidepressants. Evaluate: it cannot explain anger or hallucinations, and it risks blaming the client.
The biological approach to explaining and treating OCD: genetic and neural explanations; drug therapy.
OCD runs in families. Lewis found 37% of his OCD patients had a parent with the disorder and 21% a sibling. Nestadt's twin study gave 68% concordance for identical twins against 31% for non-identical, showing vulnerability is inherited. Taylor identified up to 230 candidate genes, including COMT and SERT, regulating dopamine and serotonin, meaning OCD is polygenic. The neural explanation adds low serotonin and an overactive worry circuit in the orbitofrontal cortex and basal ganglia. For treating OCD, drug therapy uses SSRIs to block reuptake at the synapse so serotonin stays in the cleft. These take 3-4 months and are often combined with CBT. Evaluate with Soomro's review of 17 trials against side effects and drug company funding.
Your focus
- Define the four main approaches to defining abnormality in psychopathology.
- Apply each definition of abnormality to specific clinical examples.
- Evaluate the strengths and limitations of each definition, including cultural bias.
Show all 19 objectives
- Describe phobias, depression and OCD separately by their behavioural, emotional and cognitive characteristics.
- Identify from a scenario whether a named symptom is behavioural, emotional or cognitive and which disorder it fits.
- Explain why an obsession is a cognition while a compulsion is the behaviour performed to reduce the anxiety it causes.
- Apply diagnostic detail such as the two-week persistence rule to judge whether described symptoms would meet DSM criteria.
- Explain the two-process model, with classical conditioning acquiring the phobia and negative reinforcement maintaining it.
- Describe systematic desensitisation and flooding and state what makes the exposure work in each.
- Apply conditioning terms to a case such as Little Albert, labelling the NS, UCS, CS and conditioned response.
- Evaluate the two therapies using Gilroy's follow-up against flooding's dropout rate and ethical cost.
- Describe Beck's negative triad and Ellis's ABC model, expanding each letter and naming each part of the triad.
- Apply the ABC model to a described event, showing that the belief and not the event produces the consequence.
- Explain how CBT challenges irrational thoughts by empirical and logical disputing plus homework tasks.
- Evaluate cognitive treatment using March's 81% improvement against the risk of blaming the client for the illness.
- Outline the genetic explanation of OCD, naming candidate genes and quoting Nestadt's twin concordance rates.
- Describe the neural explanation, covering low serotonin and the orbitofrontal cortex and basal ganglia worry circuit.
- Explain how an SSRI keeps serotonin in the synaptic cleft and how long a course usually takes to work.
- Evaluate drug therapy using Soomro's trial evidence against side effects and drug company sponsorship.
Clinical Psychology and Mental Health exam tips
Marking Points
- Define statistical infrequency as identifying behaviours outside the normal distribution curve.
- Explain deviation from social norms as behaviour violating implicit rules of a culture.
- Describe failure to function adequately using criteria like observer discomfort and unpredictability.
- Outline Jahoda's criteria for ideal mental health, including autonomy and resistance to stress.
- Evaluate definitions of abnormality by discussing cultural relativism and varying norms.
- Behavioural characteristics: phobias give avoidance, endurance and panic; depression gives changed activity levels, disrupted sleep and eating and self-harm; OCD gives compulsions and avoidance.
- Emotional characteristics: fear and anxiety in phobias; lowered mood, anger and lowered self-esteem in depression; anxiety, distress, guilt and disgust in OCD.
- Cognitive characteristics: selective attention and irrational beliefs in phobias; absolutist thinking, negative bias and poor concentration in depression; obsessive thoughts with insight in OCD.
- Credit for the precise distinction that an obsession is a cognition and a compulsion is the behaviour performed to reduce the anxiety it causes.
- Credit for using diagnostic language accurately, such as noting that depressive symptoms must persist for around two weeks to meet DSM criteria.
- Two-process model: classical conditioning acquires the phobia by association, operant conditioning maintains it through negative reinforcement from avoidance.
- Correct use of conditioning terms, with the neutral stimulus, unconditioned stimulus and conditioned response identified in an example such as Little Albert.
- Systematic desensitisation described as relaxation training plus an anxiety hierarchy plus gradual exposure, working through reciprocal inhibition.
- Flooding described as immediate, prolonged exposure with no hierarchy, ending in extinction when the adrenaline response exhausts itself.
- Evaluation: supporting outcome evidence such as Gilroy's follow-up, the cost and speed of flooding against its high dropout and ethical cost, and the model's neglect of cognition shown by phobias with no traumatic conditioning event.
- Beck's negative schema and cognitive biases, then the three elements of the negative triad named as self, world and future.
- Ellis's ABC model with each letter correctly expanded and the point that the belief, not the activating event, causes the emotional consequence.
- Named irrational beliefs such as musturbatory thinking or utopianism, used to show what an irrational belief actually looks like.
- CBT described as identifying, challenging and replacing irrational thoughts, with thought records, disputing and behavioural activation or homework.
- Evaluation: outcome evidence such as March's trial, the problem of cause versus effect in the negative triad, unsuitability for severe cases, and the alternative biological explanation.
- Genetic explanation: candidate genes such as COMT and SERT, the polygenic nature of OCD, and the diathesis-stress point that vulnerability rather than the disorder is inherited.
- Twin and family evidence quoted with figures, such as Nestadt's 68% concordance in identical twins against 31% in non-identical twins.
- Neural explanation: low serotonin and its effect on mood transmission, plus abnormal functioning of the orbitofrontal cortex, thalamus and basal ganglia worry circuit.
- Drug therapy: SSRIs preventing reuptake of serotonin in the synapse, the typical dose and course length, and alternatives such as clomipramine or an SNRI when SSRIs fail.
- Evaluation: supporting trial evidence, side effects and dropout, publication bias from drug company sponsorship, and the argument that drugs treat symptoms while leaving the cause untouched.
Examiner Tips
- 💡Use concrete examples, like intellectual disability disorder for statistical infrequency, to illustrate definitions of abnormality in psychopathology.
- 💡Always include a limitation for each definition, such as human rights abuses with social norms.
- 💡If the question names one disorder and one category, answer only that cell of the grid and give two or three characteristics with a sentence of detail each.
- 💡In scenario questions, quote the person's exact behaviour from the stem and name the category it belongs to rather than describing the disorder in general.
- 💡Characteristics questions credit knowledge and application only, so do not spend lines evaluating unless the question says discuss or evaluate.
- 💡When evaluating, ensure you link the evidence back to the specific explanation or treatment, rather than just stating the study findings.
- 💡For treatment questions, order the stages and say what the therapist does at each one; examiners credit sequence as well as content.
- 💡Use biological preparedness and the existence of phobias without any traumatic event as a competing explanation, not just as a passing criticism.
- 💡If a question names Beck or Ellis, answer on that theorist only; the other one is wasted writing.
- 💡For a discuss response, explain both cognitive accounts clearly, then develop evidence-based evaluation using named research or a competing explanation.
- 💡In application questions, pick the client's actual words from the stem and label them as the activating event, the irrational belief or the consequence.
- 💡Questions often split genetic and neural explanations, so know which studies belong to which before you start writing.
- 💡Quote concordance figures rather than saying twins are similar; providing specific evidence demonstrates a deeper understanding of the genetic explanation.
- 💡For evaluation, compare drugs with CBT on cost, dropout and relapse rather than simply saying drugs are effective.
Common Mistakes
- Treating statistical infrequency as always negative; correction: rare traits like high IQ are desirable.
- Confusing failure to function adequately with deviation from social norms; correction: failure to function focuses on individual coping, social norms on societal expectations.
- Assuming Jahoda's criteria are universally applicable; correction: traits like self-actualisation are culturally specific.
- Putting compulsions in the cognitive column and obsessions in the behavioural column, which reverses the one distinction the question is testing.
- Describing a phobia as simply a fear of something, when the marks are for the disproportionate anxiety, the avoidance and the irrational belief.
- Giving causes or treatments instead of characteristics, so an answer on OCD drifts into serotonin and earns nothing on a characteristics question.
- Explaining only the classical conditioning half, so the answer never says why the phobia persists when the person is never bitten again.
- Calling avoidance positive reinforcement, when the reinforcement is negative because an unpleasant feeling is removed rather than a reward added.
- Describing systematic desensitisation as just facing the fear, leaving out the relaxation training and the hierarchy that make it desensitisation rather than flooding.
- Claiming flooding is unethical and stopping there, when clients give informed consent and the real criticism is the trauma and dropout rate.
- Writing the negative triad as three negative thoughts without naming self, world and future, which is the only part examiners can tick.
- Muddling the ABC model by calling C the event and A the consequence, or leaving out the beliefs altogether.
- Saying CBT just talks about problems, when the credited detail is disputing irrational beliefs and testing them as hypotheses.
- Treating the correlation between negative thinking and depression as proof that the thinking came first.
- Saying OCD is genetic or is caused by a faulty gene, when concordance well below 100% shows environment is involved and no single gene is responsible.
- Describing SSRIs as increasing serotonin production rather than preventing its reuptake, which is the mechanism examiners look for.
- Confusing the basal ganglia and orbitofrontal cortex with structures from other topics, or naming a brain area without saying what it does in OCD.
- Treating drug side effects as an argument that the biological explanation is wrong, when they are an evaluation of the therapy, not of the explanation.