Edexcel GCSE Psychology: Psychological Problems
Topic 3: Psychological Problems — How would psychological problems affect you?
Paper 1 | Compulsory | 16 marks
This is one of the largest topics on Paper 1, covering two mental health problems (unipolar depression and addiction), their causes, their treatments, and the key studies that underpin our understanding of them. It is also one of the most likely topics to appear in the 9-mark essay question.
What are psychological problems?
Mental health refers to a person's psychological and emotional wellbeing. Around 25% of people are likely to experience a mental health problem in any given year. This topic focuses on two specific problems: unipolar depression and addiction.
How the incidence of mental health problems changes over time is an important part of this topic. People are around ten times more likely to be diagnosed with depression today than in the 1940s. The number of people seeking treatment for substance misuse has also increased over time, and internet addiction is an emerging area of concern that is only beginning to be recognised and studied.
Mental health problems affect individuals through emotional, social and occupational disruption, and they affect society through increased pressure on healthcare services, economic costs, and the ongoing challenge of reducing stigma and discrimination.
Unipolar depression
Unipolar depression is a mood disorder characterised by persistent low mood and a loss of interest in everyday activities.
Symptoms according to the International Classification of Diseases (ICD) include persistent sadness, hopelessness, loss of interest or pleasure in activities previously enjoyed, loneliness, low energy, difficulty concentrating, and in severe cases, suicidal thoughts.
Key features: women are more likely to be diagnosed with depression than men. Around 3.5 million people are estimated to suffer from depression in the UK. Teenagers and people over 50 are among the most commonly affected age groups.
Addiction
Addiction is a pattern of behaviour in which a person is unable to stop using a substance or engaging in a behaviour despite negative consequences.
Symptoms according to the ICD include repetitive, compulsive engagement in a behaviour or substance use, an inability to stop or reduce the activity, feeling compelled to use the substance, and physical withdrawal symptoms when the substance or behaviour is stopped.
Key features: between 2014 and 2015, over 141,000 people were treated for substance misuse in the UK. Those aged 18 to 24 are most likely to develop an addiction. Internet addiction is estimated to affect around 6% of people globally.
Genetic explanations
Genetic explanation of depression
Research suggests that at least 17 genes are linked to depression. McGuffin found that monozygotic (identical) twins were around 46% more likely to both develop depression if one twin was already diagnosed, compared to dizygotic (non-identical) twins. This concordance rate suggests a significant genetic component.
The diathesis-stress model proposes that some people inherit a genetic vulnerability to depression but only develop it when exposed to a stressful trigger. This explains why not everyone with a genetic predisposition will become depressed.
Evaluation
One strength is that twin studies provide strong evidence for a genetic contribution. The higher concordance in identical twins, who share 100% of their DNA, compared to non-identical twins, who share around 50%, points clearly to a genetic influence.
One weakness is that concordance is never 100%, even in identical twins, which shows that genes alone cannot be the full explanation. Environmental factors must also play a role, supporting the diathesis-stress model rather than a purely biological account.
Genetic explanation of addiction
Research suggests that a malfunction in the DRD2 gene affects dopamine receptors, reducing the brain's natural reward response. Martinez found that cocaine addicts were more likely to have a particular version of the dopamine receptor gene, suggesting some people are genetically more vulnerable to seeking external stimulation through addictive substances.
Evaluation
One strength is that genetic research into addiction has practical applications. Understanding genetic vulnerability could help identify those at risk and target prevention or early intervention accordingly.
One weakness is that, as with depression, genetics alone cannot explain addiction. Many people with the same genetic profile never develop an addiction, suggesting that environment and learning also play a significant role.
Cognitive theory as an explanation of depression
Cognitive theory proposes that depression is caused by faulty thinking patterns rather than external events alone. It is what we think about events, not the events themselves, that leads to depression.
Aaron Beck proposed the cognitive triad, which describes three interconnected patterns of negative thinking: a negative view of the self ("I am worthless"), a negative view of the world ("everything is against me") and a negative view of the future ("things will never get better").
Albert Ellis proposed the ABC model. A stands for the activating event (something happens), B stands for the belief triggered by that event (which may be rational or irrational) and C stands for the consequence (irrational beliefs lead to negative emotions and depression). Ellis argued that it is not the event but our belief about the event that determines whether we become depressed.
Evaluation
One strength is that cognitive theory has led directly to the development of CBT, a widely used and effective treatment for depression. This practical application supports the validity of the theory.
One weakness is that it is difficult to determine whether negative thoughts cause depression or whether depression causes negative thoughts. This lack of objectivity makes it hard to establish cognitive theory as a definitive cause.
Learning theory as an explanation of addiction
Learning theory proposes that addiction is learned through the same processes that shape all behaviour, rather than being caused by biological factors alone.
Classical conditioning suggests addiction develops through association. A neutral stimulus becomes associated with the pleasurable effects of a substance, eventually triggering cravings on its own. This also helps explain relapse, as returning to a familiar environment may reactivate conditioned responses years after stopping.
Operant conditioning suggests addiction is maintained through reinforcement. Positive reinforcement occurs when the substance produces a pleasurable effect. Negative reinforcement occurs when using the substance removes an unpleasant feeling such as anxiety or withdrawal symptoms.
Social Learning Theory suggests that addiction can be learned through observation. If a person sees a role model engaging in a behaviour and being rewarded for it (vicarious reinforcement), they are more likely to imitate it. This helps explain why addiction often runs in families and social groups.
Evaluation
One strength is that learning theory has practical applications. If addiction is learned, it can also be unlearned, which provides a strong rationale for behavioural therapies.
One weakness is that learning theory does not fully explain why only some people who try addictive substances go on to develop an addiction. Individual differences in genetic vulnerability are not accounted for by conditioning alone.
Cognitive behavioural therapy (CBT) as a treatment
CBT for depression
CBT aims to help patients identify and challenge the irrational or negative thought patterns maintaining their depression, and replace them with more balanced and rational thinking. The patient begins by discussing symptoms with the therapist, who then challenges negative thoughts and offers more rational interpretations. Between sessions, patients keep a mood diary and practise applying new thinking patterns in daily life.
Evaluation
One strength is that CBT is effective without relying on medication, making it a useful alternative for those who cannot or do not want to take antidepressants.
One weakness is that CBT requires active engagement and motivation. It may not be suitable for those with severe depression who struggle to engage with the process.
CBT for addiction
CBT for addiction takes place in two stages. Functional analysis involves identifying the triggers for addictive behaviour by examining which emotions, people or situations lead the person to engage in their addiction. Skills training then teaches specific strategies to manage cravings, avoid triggers and prevent relapse. Homework between sessions, such as keeping a diary of urges and responses, helps consolidate progress.
Evaluation
One strength is that CBT for addiction addresses the psychological roots of addictive behaviour rather than just the physical symptoms, which can make it more effective in the long term.
One weakness is that CBT relies heavily on the patient's motivation. Those with severe addiction or co-occurring mental health problems may find it difficult to commit to the process.
Drug therapy as a treatment
Drug therapy for depression
Antidepressant drugs work by increasing the availability of neurotransmitters such as serotonin and dopamine in the brain. The most commonly prescribed are SSRIs (selective serotonin reuptake inhibitors), which prevent serotonin from being reabsorbed after release. Other types include SNRIs, MAOIs and TCAs.
Evaluation
One strength is that antidepressants can provide relatively rapid relief from symptoms, making it easier for patients to begin engaging with other therapies such as CBT.
One weakness is that antidepressants treat symptoms rather than the underlying cause. When medication stops, patients may relapse if the thought patterns or circumstances that contributed to their depression have not been addressed.
Drug therapy for addiction
Drug treatments for substance addiction aim to reduce withdrawal symptoms and cravings. Nicotine replacement therapies help with smoking cessation, naltrexone is used for alcohol and some gambling addictions, and SSRIs are sometimes used for behavioural addictions.
Evaluation
One strength is that drug therapy can make the early stages of recovery more manageable, reducing the physical discomfort of withdrawal that often leads to relapse.
One weakness is that drug treatments can themselves become addictive or have significant side effects, and they do not address the psychological or social factors that may have contributed to the addiction.
Key studies
Caspi et al. (2003) — Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene
Aim: to investigate why stressful life events lead to depression in some people but not others, and whether a variation of the 5-HTT gene increased vulnerability.
Procedure: 847 participants from the Dunedin longitudinal study were divided into three groups based on their version of the 5-HTT gene: two short alleles (17%), one short and one long allele (51%), and two long alleles (31%). Stressful life events between ages 21 and 26 were recorded, and depression symptoms were assessed at age 26.
Results: participants with at least one short version of the 5-HTT gene who had also experienced stressful life events showed significantly higher rates of depression. Those with two short alleles and high stress showed the strongest link.
Conclusion: there is an interaction between genes and environment in the development of depression. The 5-HTT gene increases vulnerability when combined with stressful life experiences.
Strengths: the large sample of 847 participants improves generalisability. The longitudinal design allows researchers to track the relationship between genes, life events and depression over time.
Weaknesses: depression was assessed using self-report questionnaires, which may not always be accurate. The sample was limited to Caucasian non-Maori participants, restricting how widely findings can be applied.
Young (2007) — Cognitive Behaviour Therapy with Internet Addicts: Treatment Outcomes and Implications
Aim: to investigate the effectiveness of CBT as a treatment for internet addiction.
Procedure: 114 patients diagnosed with internet addiction took part in an online CBT programme. The first session gathered background information. Subsequent sessions focused on skills training. Participants completed questionnaires after sessions 3, 8 and 12, and again six months after the programme ended.
Results: most participants showed significant improvement in managing their internet use. Motivation scores increased from an average of 4.22 at the start to 4.36 six months after the programme. The majority reported managing symptoms in their personal, professional and social lives.
Conclusion: CBT is an effective treatment for internet addiction, producing improvements that are maintained over time.
Strengths: the six-month follow-up allows researchers to assess whether improvements are maintained rather than only immediately after therapy.
Weaknesses: the study lacks a control group, so it cannot be ruled out that participants might have improved without treatment. Self-report questionnaires may not accurately reflect changes in behaviour.
Issues and debates: nature and nurture
Nature refers to the idea that behaviour is determined by biological factors such as genes, brain chemistry and inherited characteristics.
Nurture refers to the idea that behaviour is shaped by environmental factors such as upbringing, learning, culture and life experiences.
The nature side of the debate is supported by the genetic explanation of both depression and addiction, and by drug treatments that work directly on brain chemistry.
The nurture side is supported by cognitive theory and learning theory. If depression is caused by faulty thinking patterns and addiction is learned through conditioning and observation, these are products of experience rather than biology alone. The success of CBT as a treatment supports this view.
The most convincing position is an interactionist one. Caspi et al. (2003) provides compelling evidence: the 5-HTT gene alone did not cause depression, but when combined with stressful life events, the risk increased significantly. This suggests that genes create a predisposition, but environmental triggers determine whether that predisposition leads to a disorder.
Key terms
Unipolar depression: a mood disorder causing persistent low mood and loss of interest in everyday activities.
Addiction: a pattern of compulsive behaviour in which a person cannot stop using a substance or engaging in a behaviour despite negative consequences.
Genetic predisposition: a biological tendency to develop a particular condition due to inherited genes.
Diathesis-stress model: the idea that a person may have a genetic vulnerability to a condition but only develops it when exposed to a relevant environmental stressor.
Cognitive triad: Beck's three patterns of negative thinking associated with depression: negative view of the self, the world and the future.
Cognitive theory: an explanation that focuses on how thought processes influence behaviour and mental health.
Cognitive behavioural therapy (CBT): a psychological treatment that aims to change negative thought patterns and behaviours to reduce symptoms of mental health problems.
Functional analysis: the first stage of CBT for addiction, which identifies the triggers for addictive behaviour.
Skills training: the second stage of CBT for addiction, which teaches strategies to manage and avoid addictive behaviour.
Classical conditioning: learning through association between a stimulus and a response.
Operant conditioning: learning through the consequences of behaviour, including reinforcement and punishment.
Social Learning Theory: the idea that behaviour is learned through observing and imitating the behaviour of role models.
SSRIs: selective serotonin reuptake inhibitors, a type of antidepressant that increases the availability of serotonin in the brain.
Nature: the idea that behaviour is determined by biological factors including genes and brain chemistry.
Nurture: the idea that behaviour is shaped by environmental factors including upbringing, learning and life experience.
5-HTT gene: a gene involved in regulating serotonin levels, with a short version linked to increased vulnerability to depression following stressful life events.
Looking for revision resources for this topic? The Psychological Problems Knowledge Organiser covers all of the above in a format designed for efficient revision.