Psychological Problems: Types and Treatments

What you'll learn

This revision guide covers the OCR GCSE Psychology specification on psychological problems, focusing on mental health disorders and their treatments. You'll learn about depression as a specific disorder, biological and psychological explanations for mental health problems, and evidence-based treatments including drug therapy and cognitive behavioural therapy. This knowledge is essential for Paper 2 and forms approximately 25% of your final examination.

Key terms and definitions

Depression — A mental health disorder characterised by persistent low mood, loss of interest in activities, and cognitive and physical symptoms lasting at least two weeks.

Cognitive Behavioural Therapy (CBT) — A psychological treatment that challenges negative thought patterns and behaviours, helping patients develop more adaptive ways of thinking.

Antidepressants — Medications that treat depression by altering neurotransmitter levels in the brain, particularly serotonin and norepinephrine.

Biological explanation — An approach that attributes psychological problems to physical causes such as genetics, brain chemistry, or neurological dysfunction.

Cognitive explanation — An approach suggesting that mental health problems arise from dysfunctional thinking patterns and faulty information processing.

Prevalence — The proportion of a population experiencing a particular disorder at a given time, expressed as a percentage or ratio.

Relapse rate — The percentage of patients whose symptoms return after treatment has ended or been discontinued.

Placebo effect — An improvement in symptoms resulting from a patient's belief in treatment effectiveness rather than the treatment's actual pharmacological properties.

Core concepts

Understanding depression

Depression is one of the most common mental health disorders worldwide, affecting approximately 1 in 5 adults during their lifetime. The condition extends far beyond ordinary sadness and significantly impairs daily functioning.

Symptoms of depression fall into three categories:

Emotional symptoms:

• Persistent low mood or sadness
• Loss of interest or pleasure in activities (anhedonia)
• Feelings of worthlessness or excessive guilt
• Hopelessness about the future

Cognitive symptoms:

• Difficulty concentrating or making decisions
• Recurrent thoughts of death or suicide
• Negative thinking patterns
• Memory problems

Physical symptoms:

• Changes in appetite (increase or decrease)
• Sleep disturbances (insomnia or hypersomnia)
• Fatigue and loss of energy
• Psychomotor agitation or retardation

For a clinical diagnosis, symptoms must persist for at least two weeks and cause significant distress or impairment in social, occupational, or other important areas of functioning.

Biological explanations for depression

The biological approach views depression as resulting from physical factors within the body, particularly neurochemical imbalances and genetic predisposition.

The neurotransmitter hypothesis proposes that depression results from abnormally low levels of certain neurotransmitters, particularly:

• Serotonin — regulates mood, sleep, and appetite
• Norepinephrine — influences energy, attention, and arousal
• Dopamine — involved in motivation and pleasure

Evidence supporting this explanation includes:

• Post-mortem studies showing lower serotonin metabolites in depressed patients
• Brain scans revealing reduced activity in areas associated with mood regulation
• The effectiveness of antidepressant medications that increase neurotransmitter availability

Genetic factors also contribute to depression risk. Twin studies demonstrate concordance rates of approximately 40% for identical twins compared to 20% for non-identical twins, suggesting hereditary influence. However, the incomplete concordance indicates environmental factors also play crucial roles.

Strengths of biological explanations:

• Scientific evidence from brain imaging and biochemical studies
• Leads to effective pharmacological treatments
• Explains why depression runs in families

Limitations:

• Does not account for psychological or social triggers
• Cannot explain why not everyone with low serotonin develops depression
• Reductionist approach that oversimplifies complex disorders

Cognitive explanations for depression

Cognitive theories propose that depression arises from negative thinking patterns and distorted information processing rather than biological factors.

Beck's Cognitive Triad (1967) identifies three forms of negative thinking characteristic of depression:

1. Negative views about oneself — "I am worthless and inadequate"
2. Negative views about the world — "Everyone is against me; nothing goes right"
3. Negative views about the future — "Things will never improve; there's no hope"

Beck argued these negative schemas develop during childhood through negative experiences and become activated during stressful life events, leading to systematic cognitive distortions including:

• Overgeneralisation (drawing broad conclusions from single events)
• Catastrophising (expecting the worst possible outcome)
• All-or-nothing thinking (viewing situations in black-and-white terms)

Ellis's ABC Model (1962) provides another cognitive framework:

• A (Activating event) — a situation or event occurs
• B (Beliefs) — the person interprets the event through their beliefs
• C (Consequences) — emotional and behavioural responses follow

Ellis distinguished between rational beliefs (realistic, flexible) and irrational beliefs (unrealistic, rigid), with the latter leading to depression and anxiety.

Strengths of cognitive explanations:

• Explains the role of thinking patterns in maintaining depression
• Forms the basis for effective psychological treatments (CBT)
• Acknowledges the role of life experiences

Limitations:

• Unclear whether negative thinking causes depression or results from it
• Does not explain biological factors like genetic predisposition
• Cannot account for depression in individuals without obvious cognitive distortions

Drug treatments for depression

Antidepressant medications work by increasing neurotransmitter availability in the brain's synaptic gaps. The main categories include:

Selective Serotonin Reuptake Inhibitors (SSRIs):

• Examples: fluoxetine (Prozac), sertraline (Zoloft)
• Mechanism: block reuptake of serotonin, increasing its availability
• Most commonly prescribed due to fewer side effects than older medications
• Take 2-6 weeks to show therapeutic effects
• Side effects: nausea, headaches, insomnia, sexual dysfunction

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

• Examples: venlafaxine, duloxetine
• Block reuptake of both serotonin and norepinephrine
• Often prescribed when SSRIs prove ineffective

Effectiveness of drug treatments:

Research evidence:

• Cipriani et al. (2018) meta-analysis of 522 trials found all 21 antidepressants studied were more effective than placebo
• Effectiveness rates: 60-70% of patients show significant improvement
• Response typically begins after 2-3 weeks of consistent use

Strengths:

• Relatively quick and convenient treatment
• Cost-effective compared to long-term therapy
• Enables patients to function while addressing symptoms
• Strong research evidence for effectiveness

Limitations:

• Side effects can reduce compliance (patient adherence)
• Relapse rates are high when medication stops (approximately 50% within 12 months)
• Does not address underlying psychological causes
• Potential for dependency with some medications
• Less effective for mild depression compared to severe cases

Cognitive Behavioural Therapy (CBT)

CBT is a structured, time-limited psychological treatment combining cognitive and behavioural techniques to challenge negative thinking patterns and modify unhelpful behaviours.

Key components of CBT for depression:

Cognitive restructuring:

• Identifying automatic negative thoughts
• Examining evidence for and against these thoughts
• Developing balanced, realistic alternative thoughts
• Practicing new thinking patterns

Behavioural activation:

• Scheduling pleasant activities
• Breaking large tasks into manageable steps
• Monitoring mood changes in relation to activities
• Gradually increasing engagement with life

Typical CBT course structure:

• 12-20 weekly sessions lasting 50-60 minutes
• Homework assignments between sessions
• Goal-setting and progress monitoring
• Relapse prevention planning

Effectiveness of CBT:

Research evidence:

• Butler et al. (2006) meta-analysis found CBT effective for depression, anxiety, and stress-related disorders
• David et al. (2008) reported CBT as effective as drug treatment, with lower relapse rates
• Approximately 50-75% of patients show significant improvement

Strengths:

• Addresses underlying thought patterns, not just symptoms
• Lower relapse rates than medication alone
• No physical side effects
• Teaches lifelong coping skills
• Can be delivered individually or in groups

Limitations:

• Requires significant time commitment and patient motivation
• Waiting lists can be lengthy in NHS settings
• More expensive per person than medication
• Not suitable for all patients (e.g., those with severe symptoms preventing engagement)
• Effectiveness depends on therapist skill and patient-therapist relationship

Comparing treatments and understanding effectiveness

Combination approaches:

Research increasingly suggests that combining drug therapy with CBT produces superior outcomes compared to either treatment alone, particularly for:

• Moderate to severe depression
• Recurrent depressive episodes
• Complex cases with co-existing anxiety

Factors affecting treatment choice:

Individual factors:

• Severity of symptoms (medication often essential for severe cases)
• Previous treatment response
• Patient preference and beliefs about treatment
• Co-existing physical or mental health conditions
• Pregnancy or breastfeeding status

Practical factors:

• Access to qualified therapists
• Cost and insurance coverage
• Treatment availability and waiting times
• Cultural attitudes toward medication versus therapy

Measuring treatment effectiveness:

Researchers use multiple criteria:

• Symptom reduction (measured by standardised scales)
• Functional improvement (return to work, social activities)
• Quality of life measures
• Relapse/recurrence rates
• Side effect profiles
• Cost-effectiveness

Worked examples

Example 1: Outline one cognitive explanation for depression. [4 marks]

Model answer: Beck's Cognitive Triad proposes that depression results from three types of negative thinking. First, negative thoughts about oneself, such as viewing oneself as worthless or inadequate. Second, negative thoughts about the world, perceiving experiences as defeating or overwhelming. Third, negative thoughts about the future, believing things will never improve. Beck argued these negative schemas develop through childhood experiences and become activated during stressful events, leading to systematic distortions in thinking that maintain depressive symptoms.

Mark scheme notes: 1 mark for identifying Beck's theory, 1 mark for explaining the three components, 1 mark for development (origins/schemas), 1 mark for explaining the mechanism maintaining depression.

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Example 2: Evaluate drug treatments for depression. [6 marks]

Model answer: One strength of drug treatments is their effectiveness, supported by Cipriani et al.'s (2018) meta-analysis showing all 21 antidepressants were more effective than placebo, with 60-70% of patients showing improvement. This provides strong scientific evidence for their use.

Another strength is convenience and speed. Antidepressants are relatively quick to prescribe and require less time commitment than therapy, allowing patients to function while symptoms are addressed. This makes them accessible to more people.

However, a limitation is the high relapse rate. Approximately 50% of patients experience symptom return within 12 months of stopping medication, suggesting drugs treat symptoms rather than underlying causes. This means patients may require long-term medication or additional psychological treatment.

Additionally, side effects such as nausea, insomnia, and sexual dysfunction can reduce patient compliance, meaning some people stop taking medication before it becomes fully effective.

Mark scheme notes: 2 marks per evaluation point with elaboration. Must include both strengths and limitations. Research evidence strengthens answers.

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Example 3: Describe one difference between biological and cognitive explanations for depression. [3 marks]

Model answer: Biological explanations attribute depression to physical factors such as neurotransmitter imbalances or genetic predisposition, focusing on brain chemistry and heredity. In contrast, cognitive explanations focus on psychological factors, particularly negative thinking patterns and faulty information processing, such as Beck's Cognitive Triad. This represents a fundamental difference in whether depression is viewed as primarily a physical or mental phenomenon.

Mark scheme notes: 1 mark for identifying the key difference, 1 mark for explaining the biological focus, 1 mark for explaining the cognitive focus.

Common mistakes and how to avoid them

• Confusing symptoms with explanations — Students often describe what depression looks like rather than explaining why it occurs. When asked for an explanation, focus on causes (neurotransmitter levels, negative thinking) not symptoms (low mood, fatigue).

• Treating all explanations as equally valid — Different questions require different approaches. If asked to evaluate, you must provide strengths AND limitations. Don't just describe multiple explanations without critical analysis.

• Vague evaluation points — Writing "CBT is effective" earns few marks. Instead, reference specific research ("Butler et al. found CBT effective in 75% of cases") and explain what this means for real-world application.

• Mixing up treatment types — Be precise: SSRIs are specific antidepressants that target serotonin; not all medications work the same way. Similarly, CBT is distinct from other therapies like counselling or psychoanalysis.

• Ignoring the question focus — If asked specifically about drug treatments, don't spend half your answer discussing CBT. Stay focused on what the question asks, using comparison only when explicitly required or to strengthen evaluation.

• Failing to use psychological terminology — Generic language like "people feel sad" won't access top marks. Use proper terms: "patients experience persistent low mood and anhedonia characteristic of major depressive disorder."

Exam technique for "Psychological Problems: Types and Treatments"

• Understand command words precisely: "Outline" requires brief description without evaluation (usually 2-4 marks). "Describe" needs more detail and examples (4-6 marks). "Evaluate" demands analysis of strengths and limitations with evidence (typically 6-12 marks). "Discuss" combines description and evaluation.

• Structure extended answers systematically: For 6-mark questions, use the PEEL structure (Point, Evidence, Explain, Link). For 8-12 mark questions, write three to four developed paragraphs, balancing positive and negative evaluation points. Always include relevant research evidence where possible.

• Calculate marks-per-point accurately: For a 4-mark question, provide two developed points (2 marks each) or four basic points. For 6 marks, aim for three evaluation points or two highly developed points with research evidence. Quality trumps quantity—one well-developed point beats three superficial ones.

• Apply knowledge to scenarios: OCR frequently provides case studies. Read carefully and select relevant information. If describing how CBT would help "James who believes he always fails," explain how cognitive restructuring would challenge this specific belief, showing application rather than generic knowledge.

Quick revision summary

Depression is a common mental health disorder characterised by persistent low mood, anhedonia, and cognitive/physical symptoms. Biological explanations focus on neurotransmitter imbalances and genetic factors, while cognitive explanations emphasise negative thinking patterns like Beck's Cognitive Triad. Treatment options include antidepressant medications (particularly SSRIs) and Cognitive Behavioural Therapy. Research shows both approaches are effective, with combination treatments often producing best outcomes. Drug treatments offer quick symptom relief but have side effects and high relapse rates. CBT addresses underlying causes and provides lasting skills but requires significant time commitment.