Psychological Problems — AQA GCSE Psychology Revision Notes

What you'll learn

• What distinguishes clinical depression from ordinary sadness
• Biological and psychological explanations of depression, and the evidence for each
• How antidepressants and CBT work, and why the two are often combined
• Addiction: dependence, tolerance and withdrawal, and how they interact
• Genetic and social learning explanations of addiction, and what each explains best
• Interventions for addiction, including aversion therapy and self-management
• Why stigma persists despite awareness campaigns, and why rising rates are hard to interpret

Key terms and definitions

Mental health — a state of wellbeing in which a person can cope with the ordinary demands of life.

Unipolar depression — depression in which mood is persistently low, without episodes of mania.

Bipolar depression — a mood disorder in which depression alternates with periods of mania or elevated mood.

Neurotransmitter — a chemical that carries signals between neurons; serotonin is linked to mood regulation.

Negative schema — a framework of negative beliefs about oneself, the world and the future.

Attribution style — the habitual way a person explains events, including whether causes are seen as permanent and global.

CBT — cognitive behavioural therapy; a talking therapy that identifies and changes unhelpful thoughts and behaviour.

Addiction — a condition in which a person cannot control their use of a substance or behaviour despite harm.

Dependence — needing a substance or behaviour in order to function normally.

Tolerance — needing larger amounts to produce the same effect as before.

Withdrawal — unpleasant effects experienced when a substance is reduced or stopped.

Aversion therapy — pairing a substance or behaviour with an unpleasant experience to break its appeal.

Self-management programme — an intervention giving a person skills to monitor and control their own behaviour.

Stigma — negative labelling and social disapproval attached to a condition.

Discrimination — unfair treatment resulting from stigma.

Core concepts

Depression: what it is

The distinction from ordinary sadness is the first thing examiners look for. Clinical depression involves persistent low mood over an extended period together with changes in sleep, appetite, energy and interest, and it interferes substantially with daily functioning. Duration, severity and impairment are what clinicians assess. Sadness after a bereavement is a normal response; depression is not defined by having no trigger but by its depth, persistence and effect on the person's life.

Unipolar depression involves persistently low mood. Bipolar depression involves swings between depression and mania. The presence of mania is what separates them.

Biological explanation of depression

An imbalance in neurotransmitters such as serotonin disrupts the regulation of mood, so the cause is located in brain chemistry. Genetic vulnerability forms part of the same account — depression is more common among close relatives of those affected.

Antidepressants follow directly from this. They aim to increase the availability of neurotransmitters such as serotonin at the synapse, intending to restore normal mood regulation. They treat the proposed biological cause rather than the person's thinking or circumstances.

The evaluation is finely balanced. In favour: the medication does work for many people, and genetic evidence is real. The approach also reduces blame, treating depression as an illness rather than a weakness. Against: the direction of cause is unclear — low serotonin may be a consequence of being depressed rather than its cause. Medication does not work for everyone. And the account cannot explain why depression so often follows identifiable life events.

Psychological explanation of depression

The cognitive account locates the cause in thinking. A person holds a negative schema — a framework of beliefs about themselves, the world and the future — so neutral events are interpreted as confirming failure, and low mood is maintained. The schema shapes the interpretation rather than the events themselves doing the work.

A related idea is attribution style. A student who fails one test and concludes they are hopeless at everything and always will be has explained a single setback as permanent and applying to everything, rather than specific and temporary.

CBT follows from this explanation. It identifies unhelpful thoughts, tests them against evidence and replaces them, while changing the behaviour that maintains the low mood.

In evaluation: the cognitive account explains why two people facing identical circumstances respond differently, and it has produced an effective treatment. But it cannot easily say where the negative schema came from, it risks implying the person is responsible for their own condition, and the thinking it identifies may be a symptom of depression rather than its cause.

Comparing the treatments

Wiles and colleagues studied patients whose depression had not responded to medication. Adding CBT to their usual treatment produced improvement in a greater proportion of patients than usual care alone — evidence that CBT has value even where medication has already failed, and an argument for combining treatments rather than choosing between them.

Setting the two side by side: medication acts quickly, demands little of the patient, and can lift mood enough for other work to begin — but it carries side effects, does not address circumstances or thinking, and symptoms often return when it stops. CBT produces longer-lasting change by altering interpretation, but demands effort, motivation and weeks of sessions, and is less suitable in severe cases.

Addiction

Three linked concepts describe how addiction works.

Dependence is needing the substance or behaviour in order to function normally. It can be physical, psychological or both.

Tolerance means larger amounts are needed for the same effect. This builds escalation into the process: the dose rises, so the physical risk and the cost rise, while the original reward becomes harder to reach.

Withdrawal produces unpleasant effects when use is reduced or stopped. Resuming use relieves them, so the behaviour is negatively reinforced — the person continues partly to avoid feeling ill rather than to gain any pleasure. This is why the motivation changes over the course of an addiction, and why early explanations about why someone started tell you little about why they continue.

Explanations of addiction

Genetic explanation. Twin and family studies consistently show raised risk among close relatives. The logic of twin studies is that identical twins share all their genes while non-identical twins share about half, so a higher concordance rate in identical pairs points to a genetic contribution. It supports an inherited vulnerability and explains why some people become dependent very quickly while others do not. But concordance is never complete, so genes cannot be the whole story; relatives share environments as well as genes; and a purely genetic account offers little to someone trying to stop.

Social learning / peer influence. A teenager observes peers or admired figures using a substance, sees it rewarded with status or acceptance, and imitates the behaviour. Vicarious reinforcement — seeing someone else rewarded — is enough; the observer needs no direct experience. This accounts well for why use typically begins in adolescence and in groups, and suggests prevention through changing norms. Its limit is that it explains initiation far better than continuation, since dependence persists long after the peer group is gone. The direction may also be reversed if people select friends who already share their habits.

Interventions for addiction

Aversion therapy pairs the substance or behaviour with an unpleasant experience, so the association that made it attractive is replaced. It can produce rapid change and requires little insight, which suits people who have not responded to talking therapies. But the effect often does not survive outside the treatment setting, deliberately inducing unpleasant experiences raises serious ethical concerns about harm and consent, and because it targets the association rather than the reason for using, relapse rates are high.

Self-management programmes give the person skills to monitor their own triggers, set goals and plan responses, so control rests with them rather than a therapist. This requires motivation, which limits who it suits.

Mental health in society

The effects of significant mental health problems extend beyond the individual. There are costs in working days lost and reduced productivity, demand on health services, and strain on families providing informal care. That is the economic argument for early treatment — though presenting it only in those terms risks valuing people by their output.

Stigma and discrimination remain barriers. Awareness campaigns have reduced stigma, but knowing a condition is common does not remove the fear of how colleagues, employers or family will react. Disclosure carries real consequences for work and relationships that information alone does not change, so a person may accept the message intellectually and still conclude that seeking help is not worth the risk.

This also complicates the figures. Recorded rates of some problems have risen, but reduced stigma and better awareness mean more people come forward and more cases are diagnosed. Broader diagnostic criteria have the same effect. So a rise in recorded cases is consistent with either a real increase or with better detection of cases that previously went unrecorded, and separating the two requires consistent measures applied over long periods.

Worked examples

Example 1: Distinguishing depression from sadness

Explain one way clinical depression differs from feeling sad. (2 marks)

Depression involves persistent low mood over an extended period rather than a temporary reaction (1), and it is accompanied by changes such as disturbed sleep and loss of interest that interfere substantially with daily functioning (1).

Example 2: Applying the cognitive explanation

Amara fails a driving test and concludes she will never be able to drive and is bad at everything. Explain her thinking using the cognitive explanation of depression. (3 marks)

Amara is showing a negative attribution style (1). She has explained a single specific setback as permanent — she will never drive — and as global, applying to everything rather than just driving (1). A negative schema then leads her to interpret further events as confirming that belief, which maintains low mood (1).

Example 3: Explaining a mechanism in addiction

Explain how withdrawal symptoms can maintain an addiction. (3 marks)

Stopping or reducing the substance produces unpleasant physical and psychological effects (1). Resuming use relieves those effects, so the behaviour is negatively reinforced (1). The person therefore continues partly to avoid feeling ill rather than to obtain any pleasure, which is why the addiction persists even when the original reward has gone (1).

Example 4: Evaluating a treatment

Evaluate the use of antidepressant medication for depression. (6 marks)

Medication acts relatively quickly and requires little effort from the patient, which matters when someone is too unwell to engage with a talking therapy (2). It follows directly from the biological explanation and is supported by the improvement many patients show (2). However, it carries side effects, does nothing to address the person's circumstances or thinking, and symptoms often return when the medication stops — which is why it is frequently combined with CBT rather than used alone (2).

Common mistakes and how to avoid them

Defining depression only as "feeling sad". Duration, severity and impairment must appear.

Saying low serotonin causes depression as established fact. The evidence is correlational; the direction of cause is genuinely unclear. Saying so is an evaluation mark.

Confusing unipolar and bipolar. Bipolar includes mania. Unipolar does not.

Describing CBT as "talking about your problems". It identifies specific unhelpful thoughts, tests them against evidence and changes behaviour. Be concrete.

Treating tolerance and withdrawal as the same. Tolerance is needing more for the same effect; withdrawal is what happens when you stop.

Explaining addiction only by how it started. Peer influence explains initiation; withdrawal and dependence explain continuation. Questions often want both.

Saying twin studies prove addiction is genetic. Concordance is never complete, and twins share environments too.

Assuming rising rates mean rising illness. Better detection produces the same figures.

Exam technique for Psychological Problems

Match the explanation to the treatment. Biological explanation → medication. Cognitive explanation → CBT. Learning explanation → aversion therapy. Questions frequently test whether you see the link, and an answer that pairs them correctly reads as understanding rather than recall.

Be sensitive in wording. Write about people who have depression, not "depressives". It costs nothing and poor phrasing reads badly.

For the nature–nurture questions, take the interaction position. An inherited vulnerability may only produce the condition given certain circumstances. That is the position the evidence supports, and it earns more than picking a side.

Name Wiles when discussing treatment effectiveness. One sentence on what it showed is enough, and it is the study this topic expects.

On ethics of aversion therapy, be specific. The concern is deliberately inducing an unpleasant experience, and whether genuine consent is possible from someone desperate to stop.

Handle the stigma question as a social one. The reason awareness alone fails is that disclosure has real consequences. That is the insight the marks are for.

Quick revision summary

• Depression requires persistent low mood plus functional impairment, not simply sadness
• Unipolar has no mania; bipolar alternates with mania
• Biological explanation: serotonin imbalance and genetic vulnerability → antidepressants
• Weakness: cause and effect unclear; low serotonin may follow depression rather than cause it
• Cognitive explanation: negative schema and negative attribution style → CBT
• Weakness: cannot say where the schema came from; may describe a symptom
• Wiles: adding CBT helped patients whose medication had already failed
• Dependence = needing it; tolerance = needing more; withdrawal = effects of stopping
• Withdrawal negatively reinforces use, so motivation shifts from pleasure to avoiding illness
• Genetic explanation rests on twin concordance — real but never complete
• Peer influence and vicarious reinforcement explain initiation, not continuation
• Aversion therapy works fast but relapse is high and the ethics are contested
• Self-management hands control to the person but needs motivation
• Stigma persists because disclosure has real social and employment consequences
• Rising recorded rates may reflect better detection rather than more illness