What you'll learn
This revision guide covers the WJEC GCSE Psychology specification content on mental health problems and their treatment. You'll learn how psychologists classify and diagnose mental health conditions, understand depression in detail, and explore different treatment approaches including biological and psychological therapies. This knowledge is essential for Paper 2 of your WJEC GCSE Psychology examination.
Key terms and definitions
Mental health problem — A psychological condition that causes significant distress or impairment in daily functioning, affecting thoughts, emotions or behaviour.
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) — The classification system used by mental health professionals to diagnose psychological disorders based on specific criteria.
Depression — A mood disorder characterised by persistent low mood, loss of pleasure in activities, and other cognitive and physical symptoms lasting at least two weeks.
Unipolar depression — Depression involving only low mood episodes, without the manic (extremely high mood) episodes seen in bipolar disorder.
Cognitive Behavioural Therapy (CBT) — A psychological treatment that focuses on changing negative thought patterns and behaviours to improve mental health.
Antidepressant medication — Drugs that work on neurotransmitters in the brain to alleviate symptoms of depression, such as SSRIs (Selective Serotonin Reuptake Inhibitors).
Relapse — The return of symptoms after a period of improvement or recovery from a mental health problem.
Stigma — Negative attitudes, beliefs and discrimination towards people with mental health problems, often based on stereotypes and lack of understanding.
Core concepts
Classification and diagnosis of mental health problems
Mental health professionals use standardised classification systems to diagnose psychological disorders. The DSM-5 is the main system you need to know for WJEC GCSE Psychology.
Purpose of classification systems:
- Provide clear diagnostic criteria for mental health conditions
- Enable reliable diagnosis across different clinicians
- Facilitate communication between professionals
- Guide treatment decisions
- Support research into causes and treatments
How the DSM-5 works:
- Lists specific symptoms required for diagnosis
- Specifies duration criteria (how long symptoms must be present)
- Identifies severity levels (mild, moderate, severe)
- Considers functional impairment (how symptoms affect daily life)
Strengths of classification systems:
- Increases reliability of diagnosis
- Allows comparison of research findings
- Reduces bias in diagnosis
- Helps insurance and healthcare systems allocate resources
Limitations of classification systems:
- May oversimplify complex human experiences
- Risk of labelling and stigma
- Cultural differences in symptom expression may be overlooked
- Symptoms overlap between different disorders
- Can lead to self-fulfilling prophecies
Understanding depression
Depression is a mood disorder affecting approximately 1 in 6 adults in the UK at some point in their lives. The WJEC specification requires detailed knowledge of unipolar depression.
Key symptoms of depression (DSM-5 criteria):
Emotional symptoms:
- Persistent sad, low or empty mood
- Loss of interest or pleasure in activities (anhedonia)
- Feelings of worthlessness or excessive guilt
- Feelings of hopelessness about the future
Cognitive symptoms:
- Difficulty concentrating or making decisions
- Recurrent thoughts of death or suicide
- Negative thinking patterns
- Poor memory
Behavioural symptoms:
- Social withdrawal and isolation
- Reduced activity levels
- Self-harm behaviours
- Changes in speech (slower, quieter)
Physical symptoms:
- Sleep disturbances (insomnia or hypersomnia)
- Changes in appetite and weight
- Fatigue and loss of energy
- Psychomotor agitation or retardation (restlessness or slowed movements)
Diagnostic criteria:
- At least five symptoms must be present
- Symptoms must persist for at least two weeks
- Must include either depressed mood or loss of interest/pleasure
- Symptoms must cause significant distress or impairment
- Not attributable to substance use or another medical condition
Types of depression:
- Major depressive disorder (severe episode)
- Persistent depressive disorder (dysthymia - chronic, less severe)
- Seasonal affective disorder (SAD - related to winter months)
- Postnatal depression (after childbirth)
Explaining depression: biological approach
The biological approach explains depression through physical factors in the brain and body.
Genetic explanation:
- Depression runs in families, suggesting hereditary factors
- Twin studies show higher concordance rates in identical twins (46%) compared to non-identical twins (20%)
- No single "depression gene" exists; multiple genes contribute
- Genetic vulnerability interacts with environmental triggers
Biochemical explanation (neurotransmitter hypothesis):
- Depression linked to imbalances in brain neurotransmitters
- Serotonin - regulates mood, sleep and appetite; low levels associated with depression
- Noradrenaline - involved in alertness and energy; deficiency linked to fatigue and lack of motivation
- Dopamine - associated with pleasure and reward; low levels linked to anhedonia
Evaluation of biological explanations:
Strengths:
- Supported by effectiveness of antidepressant drugs that alter neurotransmitters
- Twin and family studies provide evidence for genetic component
- Brain imaging shows differences in people with depression
- Scientific and objective approach
Limitations:
- Reductionist - ignores psychological and social factors
- Cannot explain why not everyone with genetic risk develops depression
- Correlation between neurotransmitters and depression doesn't prove causation
- Takes responsibility away from individual (deterministic)
Explaining depression: cognitive approach
The cognitive approach focuses on negative thought patterns and how they contribute to depression.
Beck's negative triad (1967):
Aaron Beck proposed that depression results from negative schemas (core beliefs) developed in childhood through negative experiences.
The negative triad consists of:
- Negative views about oneself ("I am worthless")
- Negative views about the world ("Everyone is against me")
- Negative views about the future ("Things will never improve")
Cognitive distortions:
- Overgeneralisation - drawing broad conclusions from single events
- Catastrophising - always expecting the worst outcome
- Personalisation - blaming oneself for things outside personal control
- Black-and-white thinking - seeing things as all good or all bad
- Selective attention - focusing only on negative aspects
Ellis's ABC model (1962):
- A (Activating event) - situation that triggers thoughts
- B (Beliefs) - rational or irrational thoughts about the event
- C (Consequences) - emotional and behavioural responses
Irrational beliefs lead to unhealthy emotional consequences and depression.
Evaluation of cognitive explanations:
Strengths:
- Research evidence supporting link between negative thinking and depression
- Explains why people react differently to same situations
- Led to effective treatment (CBT)
- Considers role of individual's thoughts and perceptions
Limitations:
- Unclear if negative thinking causes depression or results from it
- Ignores biological factors
- May blame individuals for their depression
- Cannot explain all cases of depression (e.g., where no obvious negative thinking present)
Biological treatments for depression
Antidepressant medication:
The main type you need to know is SSRIs (Selective Serotonin Reuptake Inhibitors).
How SSRIs work:
- Block reuptake of serotonin at synapses
- Increases serotonin availability in the synaptic gap
- Enhances neurotransmission in neural pathways affecting mood
- Examples: fluoxetine (Prozac), sertraline (Zoloft), citalopram
Effectiveness:
- 50-65% of people show improvement with antidepressants
- Usually take 2-4 weeks to show effects
- Most effective for moderate to severe depression
- Often combined with psychological therapy for best results
Strengths of drug treatment:
- Relatively quick and easy to administer
- Cost-effective compared to long-term therapy
- Supported by research evidence
- Allows people to function while receiving other support
- Useful when depression is severe and prevents engagement in therapy
Limitations of drug treatment:
- Side effects (nausea, weight gain, sexual dysfunction, insomnia)
- Doesn't address underlying psychological causes
- High relapse rates when medication stops
- Some people don't respond to medication
- Risk of dependency
- Doesn't teach coping strategies
- Ethical concerns about medicating psychological problems
Psychological treatments for depression
Cognitive Behavioural Therapy (CBT):
CBT combines cognitive therapy (changing thoughts) with behavioural therapy (changing actions).
Structure of CBT:
- Usually 12-20 weekly sessions lasting 50-60 minutes
- Collaborative relationship between therapist and client
- Focus on present problems rather than past
- Homework assignments between sessions
Key techniques:
Cognitive restructuring:
- Identify negative automatic thoughts
- Challenge and test these thoughts
- Replace with more balanced, realistic thoughts
- Keep thought diaries to monitor patterns
Behavioural activation:
- Increase engagement in pleasurable activities
- Break tasks into manageable steps
- Develop problem-solving skills
- Improve social interactions
Effectiveness of CBT:
- 50-75% of people show significant improvement
- Particularly effective for mild to moderate depression
- Benefits maintained long-term (lower relapse rates than medication alone)
- As effective as antidepressants for many people
- Combination of CBT and medication most effective for severe depression
Strengths of CBT:
- Addresses underlying thought patterns, not just symptoms
- Provides coping strategies for future difficulties
- No physical side effects
- Empowers individuals to manage their own mental health
- Research evidence supports effectiveness
- Works for various mental health problems
Limitations of CBT:
- Requires motivation and engagement from client
- Time-consuming and expensive
- Waiting lists for NHS therapy can be long
- Not suitable for severe depression where thinking is very impaired
- Requires trained therapists (availability issues)
- May not address deeper emotional issues
- Cultural variations in effectiveness
Reducing stigma around mental health
What is stigma?
Stigma refers to negative attitudes and discrimination towards people with mental health problems. It can be:
- Public stigma - prejudice and discrimination from others
- Self-stigma - internalised negative beliefs about oneself
- Structural stigma - institutional policies that disadvantage people
Effects of stigma:
- Prevents people seeking help
- Reduces employment and housing opportunities
- Leads to social isolation
- Worsens mental health symptoms
- Reduces self-esteem
- Affects relationships
Ways to reduce stigma:
Education and awareness:
- Mental health education in schools
- Public campaigns (e.g., Time to Change in UK)
- Sharing accurate information about mental health
- Celebrity and public figure disclosures
Contact and interaction:
- Meeting people with mental health problems
- Sharing personal experiences
- Peer support groups
- Workplace mental health champions
Language and representation:
- Using person-first language ("person with depression" not "depressive")
- Accurate media portrayal of mental health
- Challenging stereotypes and discrimination
- Avoiding terms like "crazy" or "psycho"
Policy and practice:
- Workplace mental health policies
- Anti-discrimination legislation
- Parity of esteem (treating mental and physical health equally)
- Improved access to services
Worked examples
Example 1: Explain one strength and one limitation of using the DSM-5 to diagnose depression. [4 marks]
Model answer:
One strength of using the DSM-5 is that it increases reliability of diagnosis. The DSM-5 provides specific criteria that must be met (e.g., at least five symptoms present for two weeks), which means different clinicians are more likely to reach the same diagnosis for the same patient, improving consistency.
One limitation is that it may lead to labelling and stigma. Once someone receives a diagnosis of depression using the DSM-5, they may be stereotyped or discriminated against, which could worsen their condition or prevent them from seeking help in future due to fear of the label.
Mark scheme guidance: 2 marks for strength (1 mark identification, 1 mark elaboration), 2 marks for limitation (1 mark identification, 1 mark elaboration). Must relate specifically to DSM-5 and depression.
Example 2: Describe how SSRIs work as a treatment for depression. [4 marks]
Model answer:
SSRIs (Selective Serotonin Reuptake Inhibitors) work by blocking the reuptake of serotonin at the synapse. Normally, after serotonin is released into the synaptic gap, it is reabsorbed by the presynaptic neuron. SSRIs prevent this reabsorption, meaning more serotonin remains in the synaptic gap. This increases the amount of serotonin available to bind to receptors on the postsynaptic neuron, which enhances neurotransmission in pathways that regulate mood, thereby reducing symptoms of depression.
Mark scheme guidance: 4 marks available for accurate description of mechanism. Must mention: blocking reuptake, serotonin, synaptic gap, increased availability, and effect on mood. Award marks for detail and accuracy.
Example 3: Evaluate Cognitive Behavioural Therapy (CBT) as a treatment for depression. [6 marks]
Model answer:
One strength of CBT is that research evidence supports its effectiveness. Studies show that 50-75% of people with depression improve with CBT, and it has been found to be as effective as antidepressant medication for mild to moderate depression. This suggests CBT is a valid treatment option.
Another strength is that CBT addresses underlying thought patterns rather than just treating symptoms. It teaches people to identify and challenge negative thoughts and develop coping strategies they can use in future, which helps explain why relapse rates are lower with CBT compared to medication alone.
However, one limitation is that CBT requires considerable motivation and engagement from the client. They must attend regular sessions, complete homework tasks, and actively work on changing their thoughts and behaviours. This means CBT may not be suitable for people with severe depression who lack the energy or concentration to engage fully.
Another limitation is the practical issue of availability. CBT requires trained therapists and is time-consuming, making it expensive. NHS waiting lists can be several months long, meaning people may not receive timely treatment when they need it most.
Mark scheme guidance: 6 marks for evaluation. Award marks for: identifying strengths/limitations (1 mark each), elaboration/explanation (1 mark each), use of evidence, balance of evaluation, clear communication. Expect 2-3 well-developed points.
Common mistakes and how to avoid them
Confusing types of depression — Remember unipolar depression involves only low mood episodes, while bipolar includes manic episodes. The WJEC specification focuses on unipolar depression, so don't waste time discussing bipolar unless specifically asked.
Mixing up neurotransmitters — Learn the specific role of each: serotonin (mood, sleep, appetite), noradrenaline (energy, alertness), dopamine (pleasure, motivation). Don't just say "chemical imbalance" without naming the neurotransmitter.
Describing CBT too vaguely — Avoid just saying "CBT changes thoughts." Specify that it involves identifying negative automatic thoughts, challenging them with evidence, and replacing them with balanced alternatives, alongside behavioural activation techniques.
Only giving one-sided evaluations — When questions ask you to evaluate, always provide both strengths and limitations. Aim for balance unless the question specifically asks for one or the other.
Not using psychological terminology — Use proper terms like "cognitive distortions," "negative triad," "synaptic gap," and "reuptake" rather than everyday language. This demonstrates your psychological knowledge and gains marks.
Forgetting command words — "Describe" means provide detailed account, "Explain" means say why/how something happens, "Evaluate" means give strengths and limitations. Tailor your answer to what's being asked.
Exam technique for "Psychological Problems: Mental Health and Treatment"
Command word precision — "Outline" requires brief description (2-3 marks), "Describe" needs more detail (4-6 marks), "Explain" requires reasons/causes, "Evaluate" requires assessment of strengths and limitations. Match the depth of your answer to the marks available.
Application questions — When given scenarios, explicitly link psychological concepts to the specific details provided. For example, if describing how CBT might help "Sarah who thinks she's worthless," explain how the therapist would challenge that specific thought using cognitive restructuring.
Structure extended answers — For 6+ mark questions, use clear paragraphs for each point. Start with a point, provide evidence or explanation, then link back to the question. Use linking phrases like "Furthermore," "However," "In contrast" to show you're building an argument.
Timing and marks — Allocate approximately 1 minute per mark. A 6-mark question deserves 6 minutes and sufficient detail to earn all marks. Don't write three sentences for a 6-mark question or a full page for a 2-mark question.
Quick revision summary
Mental health problems are classified using the DSM-5, which provides specific diagnostic criteria. Depression is characterised by persistent low mood, loss of pleasure, and cognitive, behavioural and physical symptoms lasting at least two weeks. Biological explanations focus on genetics and neurotransmitter imbalances (serotonin, noradrenaline, dopamine). Cognitive explanations emphasise negative thinking patterns, including Beck's negative triad and cognitive distortions. Treatments include SSRIs (which block serotonin reuptake) and CBT (which challenges negative thoughts and increases behavioural activation). Both approaches have strengths and limitations, with combination treatment often most effective. Reducing stigma through education, contact and improved language is essential for encouraging help-seeking.