2022 May/June · Paper 42 · Q93 marksMood (affective) disorders
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Practice questions
Original questions written by HomiLabs in the style of the exam, with answers and mark schemes. They are not
Cambridge past paper questions and have not been reviewed by Cambridge. Try each one before opening the answer.
Q1Impulse control disorders and non-substance addiction · Core · Paper 3 style · 4 marks
(a)Describe the main characteristics of kleptomania.[3]
(b)Outline one difference between kleptomania and pyromania.[1]
Show answer
(a) Repeated failure to resist urges to steal objects that are not needed for personal use or for their money value; a rising sense of tension or arousal before the theft; and a feeling of pleasure, gratification or relief during or immediately after stealing. The stealing is not done out of anger or revenge, and the objects are often given away, hidden or thrown away.
1 mark each for any three of: recurrent failure to control urge to steal; items not needed/of little value; tension before; relief/gratification during or after; not motivated by anger, revenge or delusion; items discarded/hoarded/returned.
(b) In kleptomania the impulse is to steal objects, whereas in pyromania the impulse is to set fires (with a fascination with fire).
1 mark: stealing vs deliberate fire-setting.
Q2Impulse control disorders and non-substance addiction · Standard · Paper 3 style · 4 marks
(a)Bilal spends many hours a day on online betting apps, chasing his losses, and has borrowed money from his relatives without telling his wife. Suggest how operant conditioning could explain why Bilal continues to gamble.[4]
Show answer
(a) Gambling is maintained by positive reinforcement – occasional wins give money and excitement (and a dopamine 'high'). Wins come on a variable-ratio schedule: they are unpredictable, so Bilal keeps betting in case the next bet pays out, and this schedule is very resistant to extinction. Near misses may also feel rewarding. Gambling may also be negatively reinforced if it lets him escape stress or worry about his debts, so 'chasing losses' continues.
1 mark: positive reinforcement from wins. 1 mark: variable-ratio / partial reinforcement schedule. 1 mark: resistance to extinction / near misses. 1 mark: negative reinforcement or application to Bilal's chasing losses.
Q3Impulse control disorders and non-substance addiction · Standard · Paper 3 style · 6 marks
(a)Describe imaginal desensitisation as a treatment for gambling disorder.[6]
Show answer
(a) Based on classical conditioning and systematic desensitisation. The client is first taught progressive muscle relaxation. Then, while relaxed, they imagine scenes that would normally trigger the urge to gamble (e.g. walking past a betting shop, having money in their pocket, seeing a match on TV), imagining themselves feeling the urge but not gambling and leaving the situation. Over several short sessions (often guided by recordings for practice at home), the relaxation response is paired with the cues, so the arousal and tension that drive the urge are reduced. It aims to break the link between gambling cues and arousal so the person can resist the urge.
1 mark each for up to 6 of: based on conditioning/reciprocal inhibition; relaxation training; imagined gambling cues/scenes; imagining resisting the urge and leaving; repeated sessions/audio recordings; reduces arousal/tension linked to cues; aim to weaken cue–urge association; may be compared with aversion therapy.
Q4Impulse control disorders and non-substance addiction · Standard · Paper 3 style · 4 marks
(a)Outline the feeling-state theory of behavioural addiction.[4]
Show answer
(a) Miller's feeling-state theory proposes that an addictive behaviour (e.g. gambling or stealing) becomes linked with an intense positive feeling at a particular moment – such as a feeling of success, power or excitement – forming a 'feeling-state' (a memory combining the sensations, emotions, thoughts and the behaviour). Later, when the person experiences an unmet need or negative emotion, the feeling-state is triggered, producing an urge to repeat the behaviour to get that feeling again. Treatment (the feeling-state addiction protocol) aims to identify and break up these feeling-states, e.g. using eye-movement techniques.
1 mark: positive feeling linked to the behaviour. 1 mark: forms a feeling-state memory (sensations, emotions, cognitions). 1 mark: triggered later by negative emotions/unmet needs, producing the urge. 1 mark: treatment link (identify and process feeling-states).
Q5Impulse control disorders and non-substance addiction · Standard · Paper 4 style · 4 marks
(a)Explain why the K-SAS (Kleptomania Symptom Assessment Scale) is useful for measuring kleptomania, and give one weakness of using it.[4]
Show answer
(a) It is a self-report rating scale that asks about the key features of kleptomania over the past week, e.g. how strong and frequent urges to steal were, how much time was spent thinking about stealing, and how much distress was felt, giving a total score. Because it gives quantitative scores, it can be used to compare patients and to measure change before and after treatment. Weakness: it relies on honest self-report; people may under-report stealing because it is illegal and embarrassing (social desirability), so scores may not be valid.
1 mark: self-report rating scale of symptoms. 1 mark: example items (urges, thoughts, time, distress). 1 mark: strength – quantitative/compare/track change. 1 mark: weakness explained.
Q6Impulse control disorders and non-substance addiction · Challenge · Paper 4 style · 10 marks
(a)Plan a study to investigate whether covert sensitisation reduces the urge to steal in people with kleptomania. Your plan must use a self-report rating scale and an experiment with an independent measures design.[10]
Show answer
(a) Sample: e.g. 40 adults diagnosed with kleptomania, recruited through psychiatric clinics (volunteer/opportunity), with consent. Design: independent measures; randomly allocated to covert sensitisation or a waiting-list/relaxation control. IV: type of treatment. Covert sensitisation: patients imagine the urge to steal, then immediately imagine aversive consequences (e.g. being caught by security, embarrassment in front of family, or nausea), over 8 weekly sessions with home practice. DV: urge to steal measured by a self-report scale, e.g. the K-SAS or an urge rating of 0 (no urge) to 10 (overwhelming urge), completed weekly and at a 3-month follow-up; plus number of thefts reported. Controls: same number and length of sessions, same therapist training, rating completed in private. Ethics: informed consent, confidentiality (thefts are illegal), right to withdraw, controls offered treatment afterwards. Analysis: compare mean change scores.
Level 4 (9–10): plan fully meets the requirements – independent measures with allocation, self-report scale with example items/anchors, covert sensitisation described, sample, procedure, controls, ethics; replicable. Level 3 (6–8): most features with some detail. Level 2 (3–5): basic plan, some requirements missing. Level 1 (1–2): very limited.
Q7Impulse control disorders and non-substance addiction · Challenge · Paper 3 style · 10 marks
(a)Evaluate explanations of impulse control disorders and non-substance addiction, including a discussion about reductionism.[10]
Show answer
(a) Points may include: behavioural explanation (operant conditioning, variable-ratio reinforcement) is supported by the persistence of gambling and the design of gambling machines, and leads to treatments such as imaginal desensitisation; but it cannot explain why only some people who gamble develop a disorder. Biological explanations (dopamine reward pathways, possible genetic vulnerability) are supported by the use of opioid antagonists such as naltrexone reducing urges; but correlations between brain activity and gambling do not prove cause. Feeling-state theory explains individual differences in triggers but has limited research support and relies on subjective reports. Reductionism: biological and behavioural explanations reduce complex behaviour to single factors (neurotransmitters, reinforcement) – useful for treatment but ignore social, cultural and economic influences (e.g. availability of online betting); a more holistic, interactionist view combining biology, learning and cognition may be better. Also: nature/nurture, determinism, usefulness, cultural differences.
Level 4 (9–10): balanced, detailed evaluation of at least two explanations with evidence; reductionism explicitly and effectively discussed; well organised. Level 3 (6–8): reasonable evaluation; named issue discussed. Level 2 (3–5): limited, may be mostly descriptive; named issue brief. Level 1 (1–2): basic, anecdotal.
Q8Schizophrenia spectrum and psychotic disorders · Core · Paper 3 style · 4 marks
(a)Outline the difference between positive and negative symptoms of schizophrenia, giving one example of each.[4]
Show answer
(a) Positive symptoms are experiences or behaviours added to normal functioning, e.g. hallucinations (hearing voices) or delusions (false beliefs such as being persecuted). Negative symptoms are a loss or reduction of normal functioning, e.g. avolition (lack of motivation), alogia (poverty of speech) or flat affect.
1 mark: positive = additions to normal experience. 1 mark: example. 1 mark: negative = loss/reduction of normal function. 1 mark: example.
Q9Schizophrenia spectrum and psychotic disorders · Standard · Paper 3 style · 6 marks
(a)Describe the dopamine hypothesis of schizophrenia.[6]
Show answer
(a) The hypothesis states that schizophrenia is associated with abnormal dopamine activity. Excess dopamine activity, or over-sensitive/too many D2 receptors, in the mesolimbic pathway is linked to positive symptoms such as hallucinations and delusions. Later versions suggest low dopamine activity in the mesocortical pathway (prefrontal cortex) is linked to negative and cognitive symptoms. Evidence: drugs that increase dopamine (e.g. amphetamines) can produce psychotic-like symptoms; typical antipsychotics block D2 receptors and reduce positive symptoms; the dose of antipsychotics needed relates to how strongly they bind to D2 receptors.
1 mark each for up to 6 points: excess dopamine; D2 receptors (sensitivity/number); mesolimbic → positive symptoms; low prefrontal dopamine → negative symptoms; amphetamine evidence; antipsychotics block D2; L-dopa evidence; revised hypothesis.
Q10Schizophrenia spectrum and psychotic disorders · Standard · Paper 3 style · 4 marks
(a)Outline Frith's cognitive explanation of schizophrenia.[4]
Show answer
(a) Frith proposed that schizophrenia involves a deficit in metarepresentation – the ability to reflect on our own thoughts and intentions. A failure of self-monitoring means the person does not recognise their own inner speech or actions as self-generated, so they experience them as coming from an outside source (auditory hallucinations, delusions of control). A deficit in central control (willed action) means they cannot suppress automatic responses, producing disorganised speech and thought (e.g. derailment) and possibly negative symptoms.
1 mark: metarepresentation deficit. 1 mark: self-monitoring failure → hallucinations/delusions of control. 1 mark: central control deficit. 1 mark: link to disorganised speech/negative symptoms.
Q11Schizophrenia spectrum and psychotic disorders · Standard · Paper 3 style · 4 marks
(a)A hypothetical twin study found that 28 of 60 identical (MZ) twin pairs were concordant for schizophrenia, compared with 5 of 55 non-identical (DZ) twin pairs. Calculate the concordance rate for each type of twin, as a percentage to 1 decimal place.[2]
(b)Explain what these results suggest about the nature versus nurture debate in schizophrenia.[2]
(b) The much higher concordance for MZ twins, who share all their genes, than DZ twins, who share about half, suggests a genetic (nature) influence; but because MZ concordance is far below 100 %, environmental (nurture) factors must also play a part (diathesis–stress).
Q12Schizophrenia spectrum and psychotic disorders · Challenge · Paper 4 style · 4 marks
(a)Compare typical and atypical antipsychotic drugs as treatments for schizophrenia.[4]
Show answer
(a) Typical antipsychotics (e.g. chlorpromazine) mainly block dopamine D2 receptors and reduce positive symptoms, but often cause extrapyramidal side effects such as tremors and, with long-term use, tardive dyskinesia (involuntary movements). Atypical antipsychotics (e.g. clozapine, risperidone) act on dopamine and serotonin receptors, can help some negative symptoms and cause fewer movement side effects, but may cause weight gain, and clozapine needs regular blood tests because of the risk of agranulocytosis.
1 mark: typical – D2 blockade, positive symptoms. 1 mark: typical side effects. 1 mark: atypical – dopamine and serotonin, broader effect. 1 mark: atypical side effects/fewer motor effects.
Q13Schizophrenia spectrum and psychotic disorders · Challenge · Paper 4 style · 6 marks
(a)The Positive and Negative Syndrome Scale (PANSS) has 30 items, each rated by a clinician from 1 (absent) to 7 (extreme). Seven items form the positive scale. State the lowest and highest possible scores on the positive scale and on the whole PANSS.[2]
(b)Explain one strength and one weakness of using a clinician-rated interview scale such as the PANSS rather than a self-report questionnaire to assess schizophrenia.[4]
Show answer
(a) Positive scale: 7 to 49. Whole PANSS: 30 to 210.
B1: 7–49. B1: 30–210.
(b) Strength: trained clinicians can rate symptoms that patients may lack insight into (e.g. they may not see their delusions as unusual), and a structured interview with defined anchors gives standardised, quantitative scores that can track change. Weakness: ratings depend on the clinician's judgement, so they can be subjective or biased (e.g. by expectations of a treatment), and the interview is time-consuming and requires training.
Strength: 1 mark identification, 1 mark explanation (insight/standardised). Weakness: 1 mark identification, 1 mark explanation (subjectivity/inter-rater reliability/time).
Q14Schizophrenia spectrum and psychotic disorders · Challenge · Paper 3 style · 10 marks
(a)Evaluate treatment and management of schizophrenia, including a discussion about ethics.[10]
Show answer
(a) Points may include: antipsychotics are effective in reducing positive symptoms and relapse, allowing many patients to live in the community; but side effects (tardive dyskinesia, weight gain) raise ethical concerns, and patients may lack capacity to consent or be treated compulsorily. Token economies (e.g. Paul and Lentz's social-learning programme) improved self-care and social behaviour in long-stay hospital patients, but behaviour may not generalise outside the institution and withholding privileges raises ethical issues about dignity and control. CBT helps patients challenge delusional beliefs and cope with voices; it respects autonomy and has fewer side effects, but needs insight and motivation and may not suit acute patients. Ethical discussion: informed consent and capacity, right to refuse, risk–benefit balance, coercion, stigma. Also: effectiveness, generalisability, reductionism, individual differences.
Level 4 (9–10): balanced evaluation of at least two treatments with evidence; ethics thoroughly discussed. Level 3 (6–8): reasonable evaluation; ethics included. Level 2 (3–5): limited/descriptive. Level 1 (1–2): basic.
Q15Anxiety and fear-related disorders · Core · Paper 3 style · 3 marks
(a)Outline the characteristics of generalised anxiety disorder (GAD).[3]
Show answer
(a) Persistent, excessive worry about many everyday events (e.g. family, health, work or money) rather than one specific trigger, lasting for months (several months, most days), and difficult to control; with symptoms such as restlessness, muscle tension, sleep problems, difficulty concentrating, irritability and autonomic overactivity (racing heart, sweating), causing distress or impairment.
1 mark: general, excessive worry about many things. 1 mark: persistent (months, most days) / hard to control. 1 mark: physical or other symptoms (any two).
Q16Anxiety and fear-related disorders · Core · Paper 4 style · 4 marks
(a)The GAD-7 questionnaire has 7 items, each scored 0 (not at all) to 3 (nearly every day) for the past two weeks. A client's item scores are 2, 3, 1, 2, 2, 1 and 3. Calculate the client's total score and state the severity band, given the bands: 0–4 minimal, 5–9 mild, 10–14 moderate, 15–21 severe.[2]
(b)Explain one reason why a clinician should not diagnose GAD from the GAD-7 score alone.[2]
Show answer
(a) 14 – moderate anxiety.
B1: total = 14. B1: moderate.
(b) It is a short self-report screening tool; the client may over- or under-report symptoms (e.g. social desirability or misunderstanding), and the score does not check other diagnostic features such as duration, other causes or impairment, so a clinical interview is needed.
1 mark: self-report bias / screening only. 1 mark: explanation – need for interview to check diagnostic criteria.
Q17Anxiety and fear-related disorders · Standard · Paper 3 style · 4 marks
(a)Zara faints whenever she sees blood or has an injection, so she has avoided going to the dentist for years. Suggest how applied tension could be used to treat her.[4]
Show answer
(a) Applied tension targets the drop in blood pressure that causes fainting in blood-injection-injury phobia. Zara would be taught to tense the large muscles of her arms, legs and torso for about 10–15 seconds until she feels warmth in her face, then release (without fully relaxing), repeating this several times. Once she has learned the technique, she would practise it while being gradually exposed to blood-related stimuli – e.g. pictures of blood, a video of an injection, then a real finger prick – using tension at the first sign of a drop in blood pressure, so she can stay conscious and stop avoiding the dentist.
1 mark: aim – raise blood pressure / prevent fainting. 1 mark: tensing large muscle groups for a few seconds. 1 mark: practice with gradual exposure to blood/injury stimuli. 1 mark: application to Zara (dentist/injections).
Q18Anxiety and fear-related disorders · Standard · Paper 3 style · 6 marks
(a)Describe how classical conditioning explains the development of phobias. Refer to Watson and Rayner's study in your answer.[6]
Show answer
(a) A neutral stimulus becomes associated with an unconditioned stimulus that naturally causes fear, so the neutral stimulus becomes a conditioned stimulus producing a conditioned fear response. Watson and Rayner studied 'Little Albert', an 11-month-old boy who initially showed no fear of a white rat. Each time he reached for the rat, a steel bar was struck loudly with a hammer behind him (UCS), causing fear and crying (UCR). After several pairings, the rat alone (CS) caused crying and attempts to crawl away (CR). Albert's fear then generalised to similar furry objects such as a rabbit, a dog, a fur coat and a Santa Claus mask. Avoidance of the feared object is then negatively reinforced because it reduces anxiety, which maintains the phobia (two-process model).
1 mark each for up to 6 of: NS paired with UCS; becomes CS producing CR (fear); Albert, 11 months, no initial fear of rat; loud noise (steel bar) as UCS; rat alone produced fear after pairings; stimulus generalisation with examples; avoidance maintained by negative reinforcement.
Q19Anxiety and fear-related disorders · Standard · Paper 4 style · 6 marks
(a)Describe systematic desensitisation as a treatment for specific phobias.[6]
Show answer
(a) Based on classical conditioning and reciprocal inhibition – a person cannot feel relaxed and anxious at the same time. Step 1: the client learns deep muscle relaxation (and breathing). Step 2: the client and therapist build an anxiety hierarchy of situations involving the feared object, ranked from least to most frightening (e.g. for spiders: the word 'spider', a cartoon, a photo, a spider in a closed jar, holding a spider). Step 3: the client works up the hierarchy while relaxed, either in imagination (in vitro) or with real stimuli (in vivo), moving to the next step only when they can stay relaxed. The fear response is replaced (counter-conditioned) by relaxation.
1 mark each for up to 6 of: classical conditioning/counter-conditioning; reciprocal inhibition; relaxation training; hierarchy built with client; example items; gradual progression only when relaxed; in vivo/in vitro; several sessions.
Q20Anxiety and fear-related disorders · Challenge · Paper 4 style · 6 marks
(a)In a hypothetical trial for GAD in a clinic in Karachi, 35 patients received CBT and 40 patients received medication. After 12 weeks, 14 CBT patients and 6 medication patients were classed as 'recovered'. Calculate the percentage recovered in each group.[2]
(b)Explain two reasons why it would be wrong to conclude from these results alone that CBT is more effective than medication for GAD.[4]
(b) 1. Patients may not have been randomly allocated – e.g. those with milder anxiety or more motivation may have chosen CBT, so participant variables could explain the difference. 2. The measure of 'recovered' may have been made by clinicians who knew which treatment each patient received (no blinding), introducing bias; also the follow-up was short (12 weeks) and the groups were small, so long-term effectiveness is unknown.
For each reason: 1 mark identification, 1 mark explanation linked to the trial.
Q21Anxiety and fear-related disorders · Challenge · Paper 3 style · 4 marks
(a)Outline the nature versus nurture debate, and explain one reason why explanations of anxiety and fear-related disorders can be seen as supporting nurture.[4]
Show answer
(a) The nature–nurture debate concerns whether behaviour is mainly caused by inherited, biological factors (nature) or by experiences and the environment (nurture). Explanations of phobias such as classical conditioning support nurture because fear is learned through experiences: Little Albert's fear of the rat was created by pairing it with a loud noise, and fears can be learned by observing others (social learning). However, some fears (e.g. of snakes) may be easier to acquire because of evolved preparedness, which supports nature.
2 marks: outline of the debate (nature = genes/biology; nurture = environment/experience). 2 marks: reason supporting nurture explained with example (conditioning/modelling).
Q22Obsessive-compulsive and related disorders · Core · Paper 3 style · 4 marks
(a)Distinguish between obsessions and compulsions, giving an example of each.[4]
Show answer
(a) Obsessions are persistent, intrusive and unwanted thoughts, images or urges that cause anxiety, e.g. a recurring thought that one's hands are contaminated with germs. Compulsions are repetitive behaviours or mental acts that a person feels driven to perform to reduce the anxiety caused by obsessions, e.g. washing hands many times in a particular way, or checking the door is locked again and again.
Q23Obsessive-compulsive and related disorders · Standard · Paper 4 style · 5 marks
(a)The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) has 10 items: 5 about obsessions and 5 about compulsions, each scored 0 to 4. A patient's obsession item scores are 3, 3, 2, 4 and 3, and the compulsion item scores are 3, 4, 2, 3 and 3. Calculate the obsession subtotal, the compulsion subtotal and the total score, and state the severity band (0–7 subclinical, 8–15 mild, 16–23 moderate, 24–31 severe, 32–40 extreme).[3]
(b)Explain one strength of using the Y-BOCS to measure OCD.[2]
Show answer
(a) Obsessions 15, compulsions 15, total 30 – severe.
B1: 15 and 15. B1: total 30. B1: severe.
(b) It is administered by a trained clinician in a semi-structured interview, so ratings are standardised and give a quantitative score; this allows the severity of different patients to be compared and changes during treatment to be measured.
1 mark: standardised/quantitative/clinician-administered. 1 mark: allows comparison or measurement of progress.
Q24Obsessive-compulsive and related disorders · Standard · Paper 3 style · 4 marks
(a)Ahmed checks the gas stove up to 30 times before leaving home, because he fears that if the house burns down it will be his fault. Suggest how exposure and response prevention (ERP) could be used to treat Ahmed.[4]
Show answer
(a) The therapist and Ahmed build a hierarchy of situations that make him anxious about the stove, from leaving after checking 10 times up to leaving the house after not checking at all. He is exposed to each situation (e.g. turning the stove off once and walking away) and prevented from carrying out the compulsion (checking again). He stays with the anxiety until it falls (habituation), learning that the feared disaster does not happen. He moves up the hierarchy over sessions and practises as homework.
1 mark: hierarchy. 1 mark: exposure to anxiety-provoking situation. 1 mark: response prevention – not checking. 1 mark: habituation/learning feared outcome does not occur, linked to Ahmed.
Q25Obsessive-compulsive and related disorders · Challenge · Paper 4 style · 4 marks
(a)Lovell et al. compared CBT (exposure and response prevention) for OCD delivered by telephone with the same treatment delivered face to face. Explain one strength and one weakness of delivering therapy by telephone, using evidence from this study.[4]
Show answer
(a) Strength: Lovell et al. found telephone-delivered ERP was about as effective as face-to-face treatment in reducing OCD symptoms (measured with the Y-BOCS), while saving travel time and costs and making treatment accessible to people who live far away or find it hard to leave home. Weakness: the therapist cannot see the patient's body language or carry out exposure exercises together in person, and some patients may feel less supported, so it may not suit everyone (e.g. those with severe symptoms).
Strength: 1 mark identification, 1 mark linked to Lovell's finding of equivalence/accessibility. Weakness: 1 mark identification, 1 mark explanation.
Q26Obsessive-compulsive and related disorders · Challenge · Paper 3 style · 10 marks
(a)Evaluate explanations of obsessive-compulsive disorder, including a discussion about determinism.[10]
Show answer
(a) Biological: low serotonin activity is supported by the effectiveness of SSRIs in reducing symptoms; family and twin evidence suggests a genetic component; but SSRIs do not help everyone and correlation does not show cause. Cognitive (e.g. Salkovskis's inflated responsibility): intrusive thoughts are normal, but people with OCD interpret them as meaningful and feel responsible for preventing harm, leading to neutralising compulsions; supported by the success of CBT/ERP, but it is unclear whether faulty thinking causes OCD or results from it. Behavioural: compulsions maintained by negative reinforcement (anxiety reduction). Determinism: biological explanations are hard-determinist (genes/neurotransmitters cause OCD), which may reduce blame but suggests the patient has little control; cognitive explanations are softer – patients can learn to change their thoughts – which supports therapy and personal responsibility. Also: reductionism, nature/nurture, usefulness.
Level 4 (9–10): detailed, balanced evaluation of at least two explanations with evidence; determinism explicitly discussed. Level 3 (6–8): reasonable evaluation; determinism included. Level 2 (3–5): limited/descriptive. Level 1 (1–2): basic.
Q27Mood (affective) disorders · Core · Paper 3 style · 5 marks
(a)Outline the difference between a depressive disorder and bipolar disorder.[2]
(b)Describe Beck's cognitive triad.[3]
Show answer
(a) Depressive disorder involves episodes of low mood and/or loss of interest only. Bipolar disorder involves episodes of mania or hypomania (elevated or irritable mood, increased energy, reduced need for sleep), usually alternating with depressive episodes.
1 mark: depression – low mood/loss of interest only. 1 mark: bipolar – manic/hypomanic episodes (often with depression).
(b) Beck proposed that depressed people have three types of negative automatic thoughts: a negative view of the self (e.g. 'I am worthless'), a negative view of the world/experiences (e.g. 'everyone is against me') and a negative view of the future (e.g. 'things will never get better').
1 mark each for self, world and future (with example or explanation).
Q28Mood (affective) disorders · Core · Paper 4 style · 4 marks
(a)The Beck Depression Inventory (BDI-II) has 21 items, each scored 0 to 3. State the maximum possible score.[1]
(b)A patient's item scores add up to 22. Using the bands 0–13 minimal, 14–19 mild, 20–28 moderate and 29–63 severe, state the patient's level of depression.[1]
(c)Explain one weakness of the BDI as a measure of depression.[2]
Show answer
(a) 63
B1: 21 × 3 = 63.
(b) Moderate depression.
B1: moderate (22 lies in 20–28).
(c) It is a self-report questionnaire, so patients may exaggerate or minimise symptoms (e.g. social desirability, or stigma about mental illness), and it only covers the last two weeks, so scores may not be valid.
1 mark: self-report bias / snapshot of two weeks. 1 mark: explanation of effect on validity.
Q29Mood (affective) disorders · Standard · Paper 3 style · 4 marks
(a)Mehreen has felt low for months since failing her university entrance exam. She now believes she is a failure at everything and refuses to apply for any course. Suggest how cognitive-behavioural therapy (CBT) could help her.[4]
Show answer
(a) The therapist would help Mehreen identify her negative automatic thoughts (e.g. 'I fail at everything') and challenge them by looking for evidence against them, such as subjects she has done well in (reality testing). She would learn to replace them with more balanced thoughts ('I failed one exam, but I can prepare differently'). Behavioural tasks such as scheduling enjoyable activities and taking small steps towards applying to a course would provide evidence of success and improve mood. Homework such as a thought diary would help her practise between sessions.
1 mark: identify negative thoughts. 1 mark: challenge/dispute with evidence. 1 mark: behavioural activation/homework. 1 mark: application to Mehreen.
Q30Mood (affective) disorders · Challenge · Paper 3 style · 10 marks
(a)Evaluate the biological (biochemical) treatment of mood disorders, including a discussion about individual differences.[10]
Show answer
(a) Antidepressants such as SSRIs increase the availability of serotonin in the synapse; many patients improve, they are relatively cheap and easy to take, and they can be combined with therapy. Weaknesses: they take several weeks to work; side effects (e.g. nausea, sleep problems) can lead to stopping treatment; relapse is common when they are stopped; some trials suggest only small advantages over placebo for mild depression; they treat symptoms rather than causes such as negative thinking or life events. Mood stabilisers (e.g. lithium) are used for bipolar disorder but need blood monitoring. Individual differences: patients respond very differently – some need several drugs before one works, genetics and severity affect response, and some prefer psychological therapy; a nomothetic, one-size approach may not suit everyone, so combining medication with CBT tailored to the person may be best. Also: reductionism, ethics, comparison with CBT.
