HookA psychiatrist noticed his patients arguing with themselves — and built a therapy from it
In the early 1960s an American psychiatrist named Aaron Beck kept noticing something odd in his depressed patients. Beneath what they said out loud ran a second, silent stream of thought — 'I'm useless', 'nothing will ever go right', 'it's my fault' — flickering past almost too fast to catch. Beck started asking patients to write these automatic negative thoughts down. What he found was that depression was not just a mood that happened to people; it was partly a habit of thinking that people could be taught to notice and challenge. That insight grew into cognitive behaviour therapy, now one of the most used psychological treatments in the world.
Beck's story frames this whole section, because it captures its two big questions: what a psychological problem actually is, and why it happens. You will learn how psychologists define mental health and why recorded rates keep rising, how the ICD pins down the characteristics of clinical depression and addiction, the competing biological and psychological theories of each, and the therapies — drugs, CBT, aversion therapy and self-management — that each theory points towards. The examiner's favourite move throughout is matching: a theory of a disorder should line up with the therapy built on it, and your job is to show you can see the join.
ModelWhat mental health is — and why the numbers keep rising
Mental health is a person's emotional and psychological wellbeing, and psychologists describe good mental health less by the absence of problems than by a set of positive characteristics: coping with the normal stresses of life, working productively, realising your own abilities, forming and keeping relationships, and being resilient after setbacks. A significant mental health problem is one serious and lasting enough to interfere with everyday functioning — not a passing bad day. What counts as 'good' mental health also varies between cultures, which hold different beliefs about what is normal.
The incidence of recorded mental health problems has risen over time, and AQA wants you to explain why without falling into a trap. Part of the rise comes from the challenges of modern living — social isolation, long working hours, the pressures of social media — which genuinely strain wellbeing. But a large part reflects two more hopeful changes: increased recognition of the nature of mental health problems, so more people are correctly diagnosed, and a lessening of stigma, so more people feel able to come forward and seek help rather than hiding their symptoms. Rising numbers, in other words, are partly a sign of a society getting better at noticing and naming problems it once ignored.
DataThe cost — effects on individuals and society
AQA expects you to discuss the effects of significant mental health problems on two levels. For the individual, problems can damage relationships as withdrawal and irritability strain family and friendships, make it hard to cope with day-to-day life such as work, study or self-care, and harm physical wellbeing — poor sleep, changes in appetite and neglected health all take a bodily toll.
For society the effects ripple outward. There is a greater need for social care and health services to support those affected, which carries real cost. Mental health problems can contribute to higher crime rates where problems go untreated, and they carry a large economic cost through lost working days, reduced productivity and the expense of treatment and benefits. The exam point to hold is that these effects are two-way and interlinked: an individual's struggle becomes a societal cost, and a society that under-funds care worsens the individual's struggle — which is exactly why the reduction of stigma and earlier treatment matter beyond the person alone.
ModelDepression — the characteristics, and two theories of why
Clinicians define clinical (unipolar) depression using the International Classification of Diseases (ICD), which lists a cluster of symptoms that must persist for at least two weeks. The core ones are persistent low mood, loss of interest and pleasure in activities once enjoyed, and reduced energy; alongside these come disturbed sleep and appetite, poor concentration, feelings of worthlessness or guilt, and sometimes thoughts of death. Depression is a diagnosable disorder with a defined symptom set — not simply feeling sad.
AQA sets two explanations against each other. The biological theory (the influence of nature) argues depression is inherited and chemical: it runs in families, and it is linked to an imbalance of neurotransmitters — specifically low levels of serotonin, the mood-regulating chemical you met at the synapse in the brain topic. The psychological theory (the influence of nurture) is cognitive, and this is Aaron Beck's territory. It argues depression stems from faulty thinking: negative schemas — mental frameworks, built from earlier experience, that make a person interpret everything in a bleak, self-critical way — and negative attributions, the habit of blaming failures on oneself, seeing them as permanent and applying them to everything ('I failed because I'm useless, I always will be, at everything'). One theory locates the problem in the brain's chemistry; the other in the mind's habits.
MechanismTreating depression — drugs, CBT, and matching therapy to theory
Each theory of depression points to its own therapy. The biological theory points to antidepressant medication. The most common type, SSRIs (selective serotonin reuptake inhibitors), work by blocking the reabsorption of serotonin at the synapse, so more of it stays available to pass messages between neurons — directly targeting the chemical imbalance the biological theory blames. The psychological theory points to cognitive behaviour therapy (CBT): the therapist helps the client identify the automatic negative thoughts and faulty schemas Beck described, challenge whether they are actually true, and replace them with more realistic, balanced ones, while also encouraging active, rewarding behaviour.
AQA names a study on treatment effectiveness: Wiles et al. examined patients whose depression had not improved on antidepressants alone, and found that those who also received CBT were significantly more likely to improve than those who stayed on medication only — evidence that the psychological therapy adds real benefit, and that drugs and therapy can work together rather than as rivals. That combination is the heart of a good evaluation: drugs act fast and need little effort but treat symptoms rather than causes, while CBT tackles the thinking underneath but takes time, commitment and a skilled therapist.
Here is a 4-mark application question and a model answer, annotated so you can see where the marks land.
Question: 'Tom has clinical depression. His GP prescribes an antidepressant, and his therapist also begins CBT. Explain how each treatment is intended to help Tom.' (4 marks)
Model answer: 'Tom's antidepressant is likely an SSRI, which works by increasing the amount of serotonin available at his synapses; this targets the neurochemical imbalance that the biological theory says causes his low mood [this is one treatment explained AO1 and tied to the biological theory]. His CBT, by contrast, addresses the psychological cause: the therapist will help Tom notice his automatic negative thoughts and challenge the negative schemas that make him interpret events self-critically, replacing them with more balanced thinking [the second treatment, tied to the cognitive theory]. Because Tom is receiving both — as in Wiles et al.'s findings — the drug can lift his mood enough for him to engage with the therapy that tackles the underlying thinking [this applies a named study and links the two treatments to Tom specifically].'
Notice the structure: the question names two treatments, so each earns its own explanation, and each is matched to the theory it comes from. The common way to drop marks is to describe both therapies accurately but never mention Tom, or to explain how CBT works without linking it to the cognitive theory the question is really probing.
CaseAddiction — characteristics, theories and therapies
The ICD also defines addiction (dependence). Its characteristics are a strong desire or compulsion to use the substance, difficulty controlling use, tolerance (needing ever more to get the same effect), withdrawal symptoms when use stops, neglect of other interests, and continuing to use despite clear harm. As with depression, AQA sets two theories against each other. The biological theory argues addiction is inherited: a genetic vulnerability runs in families. The named evidence is Kaij's twin study of alcohol abuse, which found a higher concordance rate for alcohol abuse in identical (MZ) twins than in non-identical (DZ) twins — pointing to a genetic component, since MZ twins share more genes. The psychological theory is peer influence: people, especially teenagers, start and continue using because friends model the behaviour, make it seem normal, and pressure them to fit in.
Each theory again suggests a therapy. Aversion therapy is a behavioural treatment based on association: the substance is paired with something deeply unpleasant — for alcohol, a drug that causes violent nausea whenever alcohol is drunk — so the person learns to associate the substance with sickness and avoid it. Self-management programmes take a cognitive approach: the individual takes charge of their own recovery by identifying the triggers and high-risk situations that prompt use, monitoring their own behaviour, and building coping strategies to resist relapse. Aversion therapy tries to break the habit from the outside in; self-management rebuilds control from the inside out — and, as with depression, the strongest evaluation weighs the fast but shallow biological or behavioural fix against the slower but more durable cognitive one.
VocabularyKey terms the mark scheme pays for
TrapsMisconceptions that cost marks
ExamWhat examiners want
Psychological problems questions in AQA GCSE Psychology (8182) test all three assessment objectives, and the single most rewarded skill is matching theory to therapy. Learn the pairs cold: the biological theory of depression (low serotonin) pairs with antidepressants, and the cognitive theory (negative schemas and attributions) pairs with CBT; the biological theory of addiction (genetic vulnerability, Kaij's twin study) pairs with aversion therapy's biological logic, and the peer-influence theory sits behind self-management. AO1 asks you to describe characteristics and studies — revise the ICD symptom clusters and the named studies (Kaij, Wiles et al.) with what each showed. AO2 gives you a person — someone prescribed a drug, someone whose friends all smoke — and expects you to apply the right theory or therapy to them by name, not in the abstract.
AO3 evaluation has a dependable pattern here: weigh a biological or behavioural treatment (fast-acting, low effort, but treats symptoms and can have side effects) against a cognitive one (slower and demanding, but addresses the underlying cause and lasts). Use Wiles et al. as evidence that combining CBT with medication outperforms medication alone. On the extended 6- and 9-mark questions, the levels-based mark scheme rewards a clear line of argument — make a point, support it with a named study or the ICD, evaluate it, and answer the exact wording — so spend real time on evaluation rather than piling up description, and keep every point tied to the disorder the question actually names.