Abnormal Flashcards
To what extent do biological factors influence abnormal behaviour? DEPRESSION
Introduction:
- Abnormal behaviours are regarded within the field of psychology to be behaviours which deviate from social norms.
- The extent to which biological/cognitive/sociocultural factors influence abnormal behaviours can be explored through looking at the biological/cognitive/sociocultural etiologies of depression, a well researched abnormal disorder.
- Etiologies refer to the cause of mental illness.
- Depression is a social disorder categorised by low mood, social withdrawal, and loss of interest in activities that used to be enjoyable. There is empirical evidence that biological/cultural/sociocultural factors influence the etiology of depression.
BIOLOGICAL
Genetic predisposition
- A genetic predisposition to a disorder is an increased likelihood of developing a particular disease based on an individual’s genetic makeup. These genetic changes contribute to the development of a disease but do not directly cause it.
- Diathesis stress model
SULLIVAN ET AL (2000)
Serotonin hypothesis
- Serotonin hypothesis of depression (a prominent theory of the 1990s) argues that a reduction in serotonin reads to an increased predisposition to depression. Low levels of serotonin may result in impulsivity, suicidal thoughts and aggressive behaviour.
- Serotonin pathways are believed to control mood, emotions, aggression, sleep and anxiety.
Caspi’s research on the genetic origins of Major Depressive Disorder demonstrates a potential link to serotonin as the genes that were studied were responsible for serotonin transmission.
CASPI ET AL (2003)
EVALUATION OF BIOLOGICAL FACTORS:
- Both the studies demonstrate how biological factors influence abnormal behaviour as the research of Caspi and Sullivan can conclude that biological factors like genes and neurotransmitters can be involved in major depression.
- However it cannot be said that biological factors solely influence abnormal behaviour. This can be seen in the research described as both studies conclude how there are other factors involved in major depression, purely having a gene does not definitely say that an individual will develop the disorder, a predisposition and and serotonin levels increases that likelihood of developing the disease if other factors TRIGGER the development of the disorder (major stressful life events).
USE SOCIOCULTURAL AS AN EVALUATION COMPARISON ONE!
- A more holistic approach can argue that environmental stressors are also seen to influence abnormal behaviour, especially when looking at the etiology of depression.
BROWN AND HARRIS (1978)
Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour?
- Abnormal behaviours are regarded within the field of psychology to be behaviours which deviate from social norms.
- A key and well known study in the field of abnormal behaviour is the work of Rosenhan, who’s research looked into the diagnosis of abnormal behaviour and the validity and reliability of diagnosis.
- Reliability means clinicians should be able to reach the same conclusions consistently if they use the same diagnostic procedure and validity of diagnosis refers to receiving the correct diagnosis which should result in the correct treatment and prognosis.
- It is important to have both validity and reliability when diagnosing abnormal behaviour because mental disorders can have detrimental effects on peoples lives and a correct diagnosis can lead to individuals receiving the correct treatment which could improve their lives.
- ROSENHAN ET AL (1973)
Strengths of the study - The research had an enormous impact on psychiatry. It sparked off a discussion and revision of diagnostic procedures as well as a discussion of the consequences of diagnosis for patients. The development of diagnostic manuals has increased reliability and validity of diagnosis although the diagnostic tools are not without flaws.
- Results can be, to some extent, generalised (however, not outside the USA). Rosenhan used a range of hospitals.They were in different States, on both coasts, both old/shabby and new, research-orientated and not, well-staffed and poorly staffed, one private, federal or university funded.This allows the results to be generalised.
- There were also follow up studies in which hospitals were told ‘psuedopatients’ were coming when they weren’t, leading to many hospitals identifying real patients as fake. This further supported the inaccuracy of diagnosis.
Weaknesses of the study
- Low in historical validity. This is because the study was conducted over 40 years ago, in which time there have been major revolutions in diagnostic manuals to try and eliminate problems of misdiagnosis and unreliable diagnosis. The study itself sparked the discussion and revision of America’s diagnostic manual. Therefore, the information it provides about the reliability and validity of diagnosis may not be accurately applied to modern day situations. However, in the modern day, a repeat of an investigation like this would be unethical and so it may still be considered important in understanding the concepts.
- The study holds many ethical issues in that the participants endured horrible conditions that can be emotional harmful. It can also be said it is unfair to unnecessarily use limited hospital resources when there are so many individuals who actually need the help.
CONC:
- In conclusion, it is evident that the work of Rosenhan has made huge progress in the study of abnormal behaviour and diagnosis of abnormal behaviour
- When research, like Rosenhan’s, is conducted, a more in depth understanding of reliability and validity is produced which can lead to further research in the future. This can lead to more understanding of effective treatments for mental illnesses, that can greatly improve the quality of life of individuals
- Despite this study being very aged, it paved the way for more modern research to be conducted and allowed for development in the field of abnormal psychology
IF IT IS MORE THAN 1 USE COOPER
Evaluation of study
+ The research was standardised because both the American and the British psychiatrists were asked to diagnose patients by watching the same videotaped clinical interviews. This means that the reliability of the research is improved and its findings are more valuable when using them to investigate psychological phenomena.
- The research is ethnocentric. This is because it assumes that psychiatrists in the US and UK perceive mental disorders to be the same. The two countries work with different classification systems (DSM-5 in US and ICD-10 in UK) which is likely to lead to differences in the diagnosis. Therefore, the research gives insight into the ways in which cultural differences can reduce the reliability of diagnosis.
- The research has low mundane realism. This is because in the real world, researcher are likely to carry out more investigation than just a clinical interview. With information from self-reports and clinical tests, the researchers may have made more similar diagnosis and hence reliability would have been higher. Therefore, the research only gives an indication of the reliability of diagnosis when the diagnosis procedure is restricted to an interview only.
CONC
- In conclusion, the work of Cooper and Rosenhan made great progress in the understanding of diagnosis of abnormal behaviour, highlighting issues in reliability and validity that showed more consideration was needed in improving diagnosis
- These historic studies created the way for more modern research
- These studies also show how important it is to reach a correct diagnosis, focusing on improving validity and reliability, as diagnosis helps individuals manage their behaviour.
Examine concepts of normality and abnormality?
Abnormal psychology is the field that studies ‘abnormal behaviour’; unusual patterns or behaviour, emotions and though. Defining what in human behaviour is ‘normal’ and ‘abnormal’ can inevitably be problematic but making correct diagnoses is key as it dictates the treatment people receive.
- Abnormality can be defined as a psychological condition or behaviour that departs from the norm or is harmful/distressing to the individual or those around them. Abnormal behaviours are usually those that violate society’s ideas of what is an appropriate level of functioning.
- What has been seen as abnormal in the past has changed a great deal over time (for example homosexuality used to be viewed as abnormal) and there is still no clear definition of what constitutes normal and abnormal behaviour.
- In this essay I will examine three concepts of normality and abnormality.
PARA 1
- Psychiatrists and psychologists now use a standardised system called a diagnostic manual to help them reach a diagnosis, for example, the diagnostic and statistical manual of mental disorders (DSM - 5) is currently used by American psychologists.
- The DSM works by having psychiatrists go through five “axes” in order to consider all the factors that may be contributing to an individual’s behaviour.
Axis 1 - is the client showing symptoms
Axis 2 - their personality
Axis 3 - medical or neurological conditions that may influence the psychological problem - or how the disorder may be treated.
Axis 4 - social factors (e.g. death of a loved one?)
Axis 5 - scale of functioning out of 100.
Data triangulation is used in order to increase the validity of the diagnosis, attempting to minimise researcher bias.
The development of diagnosis manuals to help classify disorders is seen as an improvement in the objectivity of diagnosis, which helps determine normality and abnormality.
THEY ARE STILL SUBJECTIVE. Although these standardised systems are seen as a huge development they are not without faults. They are very subjective and although individual systems are standardised, they are not standardised across different countries, the US uses the DSM-5 and the UK differs using the ICD-10 (The international classification of diseases).
The ICD is seen as more objective that DSM-5 as it uses codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes or injury or diseases which allow more than 14,400 different codes and permits the tracking of many new diagnoses. However, it does not consider the personality and situation of the patient which may contribute to a possible disorder.
Another limitation of using standardised systems is that symptoms of the same disorder may vary between individuals and social and cultural groups, so psychiatric diagnosis may be biased or incorrect. They do not take into account a person’s history, personality or culture.
These limitations could make standardised systems a weaker method of examining the concepts of normality and abnormality.
IN 1958 MARIE JAGODA offered another method to examine the concept of ‘normality’ linking normality to being mentally healthy, so therefore looking at abnormality as deviation from ‘ideal’ mental health.
She argued we define physical illness through looking at the absence of signs of physical health e.g. correct body temperature, normal blood pressure, so psychiatrists should try to do the same for mental illness. She conducted a review about what others had written about mental health and identified 6 main categories which included having positive attitudes towards themselves, having an accurate perception of reality and being able to cope with stressful situations. This model proposes that the absence of these criteria indicates abnormality and potential mental disorder.
This approach that the more of these categories that are met, the healthier the individual is, thus the more ‘normal’ a person is. But this method causes much debate.
EVALUATION
- This could be seen as a positive approach to examining ‘normality’ and ‘abnormality as it ultimately focuses on what is desirable rather than undesirable. However the criticisms outweigh the strengths in this approach.
- One limitation is that the theory is ethnocentric as Jahoda is writing from the perspective of an individualist culture where independence, personal growth and self-expression are highly valued, as most of the definitions of ‘abnormality’ are devised by white, middle class men. It cannot be said that the same categories would be effective when looking at abnormality in a collectivist culture.
- It is almost impossible to measure one’s “potential for growth and development” and it is difficult to define these criteria precisely. This is seen in how jahoda said that unemployed people were deprived of some of these characteristics which may account for the reported worse mental health among the employed.
STATISTICAL INFREQUENCY
Statistical infrequency is viewed as a simpler and more obvious way to define abnormality than Jahoda’s idea of deviation from mental health. Statistics gathered from government agencies can be used to define the ‘norm’ for any group of people where a norm is typical. Therefore, if we can use data to define what is normal we are given an idea of what is not common (or abnormal).
For example, if we know the norm for age to have your first baby is between 20 and 40, it can be known that it is not the norm or it is abnormal to have a baby outside these ages.
If a graph is drawn to represent aspects of human behaviour, you get a normal distribution (illustrated by a bell shape curve). On this graph, the ‘normal’ people would be in the central group and clustered around the mean. Whereas abnormal people are the fewer cases at the extremes far away from the mean.
EVALUATION
- This is considered a stronger approach to examine abnormality and it is appropriate in some situations to use a statistical criterion to define abnormality.
- The approach is also viewed as straightforward and easy to perceive but some say that the approach is too simplistic in nature.
- This method raises issues of the cultural differences in views of normality and abnormality, as behaviours vary from one culture to the next. Behaviours that are statistically infrequent in one culture may be statistically more frequent in another, so the model is culturally relative.
- Another limitiation is that the approach inaccurately classifies high levels of skills as abnormal, simply because they are infrequent. e.g. if the quality was IQ low scores at one extreme may represent those that are ‘abnormal’ but the other high IQ could simply represent those with more desirable qualities yet they are statistically abnormal.
- The opposite is also true, 1/3 of people experience mental health problems, this is abnormal but it is normal.
CONCLUSION
• Overall, it is clear that there is a large possibility of concepts with it comes to diagnosing normal and abnormal. While psychologists currently use the diagnostic tools available, it is still worth them considering the different concepts covered in this essay to broaden their understanding of what is considered as ‘normal’.
• However, the difficulties which most of the concepts have are that they are subjective and vary between cultures and over time, and this is something that will need to be taken into consideration.
Discuss validity and reliability of diagnosis?
- Abnormal psychology is a field that studies ‘abnormal behaviour’ which is defined as unusual pattens of behaviour, emotion and thought which deviate from social norms.
- Diagnosis within abnormal psychology means identifying and classifying abnormal behaviour on the basis of symptoms, patients self reports, observations, clinical tests or other factors such as information from relatives.
- Clinicians use psychological and diagnostic manuals to help them do this. The diagnostic manuals help to classify and standardise diagnosis. Diagnosis involves matching the results of the psychological assessment with classification systems such as DSM-5 or ICD-10. The purpose of diagnosis is to find a treatment for the patient and to make a prognosis.
- An example of the most recent diagnostic manual is the DSM-5 which assesses individuals on 5 axes, including cross over of symptoms and identification of social factors. This was developed by the American Psychiatric association. It does not identify causes or etiologies but just describes symptoms.
- With an increasing number of people being diagnosed with mental illnesses, it is more important than ever to ensure that these measures of assessment allow for a reliable and valid diagnosis so that individuals do not receive unnecessary stress, medication or experience subsequent discrimination or develop a self fulfilling prophecy as a result.
RELIABILITY
- Reliability of diagnosis means clinicians should be able to reach the same conclusions consistently if they use the same diagnostic procedure (e.g. standardised clinical interview, observation of the patient’s symptoms, neuropsychological examination with scanners and diagnostic manuals). This is called inter-judge reliability.
- The introduction of diagnostic manuals has increased reliability of diagnosis over the year even though manuals are not without flaws.
- Reliability of diagnosis is a prerequisite for validity as if you ant to be able to find what you set out to test - you would expect other people having success with this too - reliability. If other people are finding different things with the same diagnostic tool is your diagnosis really valid.
- Reliability is hard to get even if you use the same tools and the standardised clinical measures because it is subjective.
- In order to ensure reliability, psychologists can assess inter-rater reliability by asking professionals to observe the same person using the same classification system and test-restest reliability by seeing if they give the same diagnosis.
COOPER AT EL (1972)
• This study can be viewed as ethnocentric as it assumes that both American and British psychiatrists perceive the mental disorders of schizophrenia and depression the same. Although they are both western cultures, there can still be differences in the ways in which they regard mental illness. This is emphasised by how both use different classification systems; the DSM-5 in the US and ICD-10 in the UK, which could lead to differences in diagnosis. So it can be said that this research gives insight into how culture can reduce the reliability of diagnosis
• The research also has low mundane realism as the diagnostic procedure used in this study is not typical of a real-life diagnosis, where there would be more intense examination of patients than just a clinical interview. Further knowledge of the patients could have led to psychiatrists making a more similar diagnosis, which would lead to a more reliable diagnosis. Therefore, this research only gives an indication of the reliability of diagnosis when the process is only restricted to clinical interviews.
VALIDITY
- Validity of diagnosis refers to receiving the correct diagnosis which should result in the correct treatment and a prognosis.
- Reliability is a prerequisite for validity, as in order for the diagnosis to be correct, there must be a unanimous agreement. If a diagnosis is not found to be consistent then it could be questioned whether it is really valid.
- It is much more difficult to provide a correct diagnosis with abnormal behaviour than making a medical one because it is not possible to observe the objective signs of the disorder in the same way and sometimes patients have symptoms that relate to different psychological disorders, making it different to make a valid diagnosis.
- A valid diagnosis is important to ensure that the patient is cared for in the best possible way avoiding any further harm. So it is key to keep looking for ways to improve validity of diagnosis, like by making sure constructs are well defined, such as what constitutes ‘normal’ and ‘abnormal’.
MITCHELL (2009)
ROSENHAN ET AL (1978)
• This study is now very dated, conducted in 1973: many years ago. The materials and procedures that are used in diagnosis have changed since this study was carried out. Therefore, it is difficult to determine how relevant this study is in providing empirical evidence for labelling and stigmatisation as an ethical consideration in diagnosis. It demonstrates the importance of reliable and valid diagnoses in the early 1970s, but the same experiment now, using modern classification systems for the diagnosis?
• Provides an explanation of how the concept of labelling and stigmatisation is experienced in a naturalistic environment and shows the importance of reliability and validity in diagnosis.
LINK TO Q – this study demonstrates how there can be a lack of validity in diagnosis as it can be clouded by confirmation bias making it unreliable , and it demonstrates how harmful a false diagnosis can be as once you’re diagnosed it is difficult to refute it, highlighting the importance of valid and reliable diagnoses.
Discuss cultural considerations in diagnosis (for example, cultural variation, stigmatisation)?
• Diagnosis of mental health refers to an individual seeking help for symptoms in which they are experiencing. A clinician uses a set of standardised instruments, the DSM-5 or ICD-10, to assess the mental health of an individual and conclude whether they are suffering from a mental illness. However, diagnosis can vary between cultures and can be interpreted in different manners.
Culture can be defined as the set of ideas, beliefs and attitudes and traditions that we share with large groups of people and gives us a sense of identity. Cultures exist within the cultural dimension suggested by Hofstede of individualism vs collectivism.
Individualist cultures such as the UK, USA and Australia emphasise individual needs and the focus is on individual success and self actualisation. In contrast, collectivist cultures such as India, Japan and China, focus on the needs of the group. The emphasis is on social harmony and the success and happiness of everyone in the group, rather than just one person.
Considering abnormality is defined as a deviation from social norms it is extremely important to consider cultural norms of each country to determine how a patient’s abnormality may be relative to their culture.
Mental health largely differs between cultures, which is clearly seen from culture bound syndromes. Culture bound syndromes- illnesses specific to certain cultures for example Gururumba condition. This specific to Papa new Guinea only, it is a condition where the sufferer (usually a married male) begins by burgling houses. He then runs to the forest with the objects he has stolen, where he hides for a number of days before returning with a case of amnesia. The sufferer appears hyperactive and clumsy, with slurred speech.
• An individual suffering from Gururumba would not be identified if these symptoms were revealed to a doctor from a Western Culture, instead they may be diagnosed with schizophrenia.
• Therefore, it is important that clinicians consider culture and acceptance of certain illnesses to ensure a valid diagnosis is made.
LI-REPAC
CULTURAL VARIATION IN SYMPTOMOLOGY
- Another cultural consideration in diagnosis is that real differences exist between cultures in the symptomology of disorders.
- An example of this can be seen by a theory produced by Marsella (2003) this theory argues that depression takes a primarily affective (emotional) form in individualistic cultures. In more collectivist societies, somatic (physiological) symptoms such as headaches are dominant. Depressive symptom patterns may actually differ across cultures because of cultural variation in sources of stress, as well as resources for coping with stress.
KLEINMAN (1984)
RACK (1982)
Rack explained that in Asian culture depression symptoms are often overlooked due to the fact that diagnosis for this disorder is vague. Doctors are usually only consulted when the patient is in physical pain and they go to the family for support.
This shows that low hospital admission rates or studies that use these statistics do not necessarily mean that there is a low prevalence for these ethnic groups for these disorders, it could just be that the cultural beliefs towards these disorders mean they do not come forward to be diagnosed.
CONCLUSION:
Overall it is evident that there are many cultural considerations which need to be taken into account when it comes to diagnosing an individual. Clinicians should look at the definitions of abnormality within the culture and their social norms. They should consider the differences in symptoms and how these are captured on the country’s assessment instruments e.g. DSM. As a result clinicians need to take an emic approach to diagnosis, rather than an etic ‘one fits all approach’.
Describe the symptoms and prevalence of anxiety disorders?
INTRO
- An anxiety disorder is a group of conditions marked by intense, often unrealistic and extreme states of fear and phobia that interfere with an individual’s daily activities and normal functions.
- One of the most common anxiety disorders is phobias, defined as overwhelming and debilitating fear of an object, place, situation, feeling or animal. Phobias develop when a person has an exaggerated or unrealistic sense of danger about a situation or object.
There are 3 types of phobias:
Specific phobias - specific or simple phobias centre around a particular object, animal, situation or activity. Often developed in childhood and adolescence and can become less sever with age.
Social phobias - a more complex type of phobia which centres around feeling anxious in social situations (social anxiety disorder) e.g. embarrassment or humiliation.
Agoraphobia - fear of open spaces, where a person will feel anxious about being in a place that they cannot escape from.
SYMPTOMS
- Symptoms of phobias can vary a great deal between individuals but there are some common symptoms/characteristics of phobias that can deal to the diagnosis of the anxiety disorder.
- Affective symptoms include feeling low or irrational levels or fear
- Behavioural symptoms include not leaving the house or repeatedly washing one’s hands.
- Cognitive symptoms include analysing one’s actions or fears as worthless
- Somatic symptoms include trembling/shaking/ throwing up, increased heart rate, nausea
- Due to the development of diagnostic manuals and changes in diagnostics, the anxiety must now be out of proportion to the actual threat or dangers.
PREVALENCE
- All phobias are more common in women than men, the biggest difference being agoraphobia. Social phobia is more common in teenagers.
- Nearly 11% of the US population (about 25,000,000 people) may suffer from a phobia during their lifetime.
- Phobias are the most common psychiatric illness in women and the second most common in men over 25.
- A fear of animals is the most common phobia (snakes and spiders)
- In the US about 15 million adults suffer from social phobia in a given year.
CONC
- It is important to be aware of the symptoms and prevalence of common anxiety disorders like phobias so psychiatrists can produce the most effective methods of diagnosis and treatments to deal with these disorders that cause problems for many individuals.
Describe symptoms and prevalence of affective disorders?
INTRO
- One of the most common mental illnesses is the Western world is that of depression, an affective disorder, which is characterised by low mood, feelings or sadness, lack of interest in things which were previously enjoyable, possible suicide and many other symptoms.
- Affective disorders are defined as mood disorders and are a set of psychiatric disorders characterised by a prolonged, pervasive, disturbance of mood together with a full or partial manic or depressive response.
SYMPTOMS
- Symptoms experienced of depression will cause clinically significant distress of impairment in social, occupational, or other important areas of functioning.
- Affective symptoms include feeling low or guilty.
- Behavioural symptoms include closing oneself off from loved ones (isolation). Loss of pleasure in activities.
- Cognitive symptoms include feelings of worthlessness and inappropriate feelings of guilt and possible suicidal thoughts.
- Somatic symptoms include fatigue, significant weight loss or weight gain.
PREVALENCE
- Depression is the most predominant mental health problem worldwide (followed by anxiety and schizophrenia).
- According to the World Health Organisation 350 million people worldwide suffer from depression.
- 20% of people over 16 in the UK have showed symptoms of depression - the percentage is higher for females than males.
CONCLUSIONS
- It is important to be aware of the symptoms and prevalence of common affective disorders, especially depression, so psychiatrists can produce the most effective methods of diagnosis and treatments to deal with these disorders that cause problems for many individuals.
- Knowing the prevalence of depression also allows psychiatrists to know the most vulnerable groups who would be more prone to the onset of depression.
Analyse biological etiologies of anxiety disorders?
INTRO
- An anxiety disorder is a group of conditions marked by intense, often unrealistic and extreme states of fear and phobia that interfere with an individual’s normal function. A type of anxiety disorder is phobias; an overwhelming and debilitating fear that come in 3 types; specific phobias, complex phobias and social phobia.
- Etiologies are the scientific causes or origins of diseases or abnormal behaviour. There are several proposed etiologies of depression, ranging, including, biological cognitive and sociocultural etiologies.
- It is important for psychologists to learn about the etiologies of phobias as they should tailor their treatment to the origin or cause of the disease. For example, if an individual’s illness is thought to have a biological origin, the treatment should be biologically based.
PHOBIAS
BIOLOGICAL
BIOLOGICAL PREPAREDNESS SELIGMAN (1971)
Most people rate animals which move unpredictably as fearful. Biological preparedness is the idea that people and animals are inherently inclined to form associations between certain stimuli (i.e. potentially life threatening) and responses, once learned, this association is difficult to extinguish.
The idea is that we inherit a predisposition to form certain associations rather than others - rather than a fixed fear of certain things. Such learning, does not, however take place in response to all stimuli as demonstrated by COOK AND MINEKA (1990). “observational conditioning of fear to fear - relevant versus fear irrelevant stimuli in rhesus monkeys”.
COOK AND MINEKA (1990)
Diathesis - Stress model - The diathesis stress theory states that psychology disorders develop due to a combination of genetic vulnerability and risk factors in the environment. So in the example above the monkeys had a genetic disposition to be afraid of the snakes because evolutionarily it helps, and it was triggered by the video.
Weakness of this theory: it does not explain a fear of harmless situations or things, such as slugs.
GENETICS
The theory of biological preparedness suggests that humans have evolved a genetic predisposition to fear certain things because of their survival value. In line with this assumption that phobias must have a genetic cause could mean that they run in families, or be shared by identical twins who will have the same genes.
- Twin studies are often used to investigate this etiology as if this was true, monozygotic twins would have the same phobias as they have identical genetic material. If genetics does play a role in a certain behaviour, one would expect monozygotic twins to have a higher concordance rate than other sibling types
VILLAFUERTE AND BURMEISTER (2003)
EVALUATION:
- The evidence is subject to alternative explanations (cog and sociocultural) and can be criticised methodologically (lack ecological validity, problems with twin studies etc.)
- Does not explain why individual people develop a phobia of particular objects e.g. octophobia.
- Does not work so well with Social Phobias – what is the evolutionary advantage?
- However it does explain why phobias persist even when unhelpful, evolution need thousands of years to work.
CONCLUSION:
- To conclude there have been many biological etiologies in relation to phobias that have evidence to support them.
- However biological etiologies do not offer explanation for an individual developing phobias in every situation, in other words not all phobias have biological causes.
- Looking purely at biological etiologies of phobias is a reductionist approach in the sense that other etiologies, like cognitive and sociocultural etiologies are also argued to be involved in the development of phobias. Therefore, one should perhaps take a more eclectic approach, applying a combination of etiologies to the development of phobias.
Examine biomedical, individual and group approaches to treatment of depression?
INTRO:
- Treatment is the use of a chemical, physical or biological agent to preserve or relieve (or eradicate) symptoms of mental disorders, including depression.
- Depression is a common mental disorder that causes people to experience depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy and poor concentration. It is the most predominant mental health problem world wide (followed by anxiety and schizophrenia).
- The success of treatment will be different for every individual.
- Factors influencing the success of a treatment include dispositional factors, such as personality, the severity and characteristics of their illness and their willingness and motivation to engage in treatment to recover.
- There are a number of different approaches to treatment, including biomedical, individual and group treatments, with ____ treatments being explored in this essay.
BIOMEDICAL TREATMENTS
- Based on the assumption that if the problem is caused by biological malfunctioning (biological etiology), drugs should be used to restore the biological system.
- This can be demonstrated with depression and the serotonin hypothesis which argues depression is known to involve an imbalance in neurotransmission of serotonin, so drugs are used to restore appropriate chemical balance in the brain.
- The most known example of biomedical treatment is antidepressants, which are used to elevate the mood of people suffering from depression, with most common groups being selective serotonin reuptake inhibitors (SSRIs) which increase the level of serotonin by preventing its re-uptake in the synaptic gap. The most common SSRI is fluoxetine (Prozac).
BIOMEDICAL TREATMENTS ARE EFFECTIVE IN TREATING DEPRESSION
- Most psychiatrists agree that drugs provide effective long-term control for mood disorders and may help to prevent suicide in depressive patients. Drugs have also been effective in reducing the numbers of hospital inpatients treated for psychological disorders (however this point may just highlight a chance in willingness to come forward or changing policies about hospitalisation.)
TADS (2007)
BIOMEDICAL TREATMENTS ARE NOT EFFECTIVE IN TREATING DEPRESSION
- Linking to the TAD’s study, the fact CBT was just as effective long term raises the question of whether these are the best treatments when there are others that are just as effective and do not have as many negative side effects.
- The use of biomedical treatments are based on the fact that problems have a biological etiology which means this is a reductionist approach as there may be other factors (sociocultural or cognitive) that play a role. This can be shown how the SSRI’s are not 100% effective.
- There are many studies that show there are other solutions to drugs, like exercise for example. Kirsch recommended that antidepressants should only be prescribed to the most depressed patients to avoid over prescriptions of SSRIs but this is difficult as this is a large market, so reducing prescriptions would not please large pharmaceutical firms.)
- Although drugs reduce symptoms, they are not a cure. This is shown in the study conducted by Neale et al (2011)
NEALE ET ALL (2011)
EVALUATION OF BIOMEDICAL TREATMENTS
- While antidepressants are thought to be capable of relieving symptoms of depression, they do not cure the illness.
- Antidepressants are associated with many side effects, including nausea, insomnia and sexual disfunction.
They are also not an effective treatment for depression in children (often cause additional suicidal thoughts). Therefore, in the UK SSRI’s are not prescribed to under 18’s unless entirely necessary.
Research implies that the placebo effect may account for the success of medication.
INDIVIDUAL TREATMENTS
- This is when therapists work one-on-one with the client.
- The most common individual treatment is cognitive behaviour therapy which is based on assumptions that depression has cognitive etiologies (Beck and depressogenic schemas) and that the symptoms of depression are cognitive (e.g. negative beliefs of someone’s self-worth). Cognitive psychologists suggest that replacing negative cognitive emotions with more realistic and positive ones can help a depressed person.
CBT stands for Cognitive behaviour therapy, it is a brief for of psychotherapy used in adults and children, which focuses on current issues and symptoms. There is usually around 12-20 weekly sessions, combined with daily practices to help the client use the new skills they learn on a day-to-day basis (behaviour modification).
Unhealthy behaviours are identified and these are then corrected in the sessions. The client is encouraged to find out which thoughts are associated with depressed feelings and then correct them (cognitive restructuring). This is needed as the cognitive processes have also become distorted, but the individual can change them. Clients are also encouraged to gradually increase any rewarding activities. Its overall aim is to teach clients to monitor thought processes and to test them against reality, so they can change their behaviour eventually.
INDIVIDUAL TREATMENTS ARE EFFECTIVE
TADS STUDY
- Whilst CBT was slow it is was just as effective as fluoxetine after 36 weeks.
- It has no side effects and it is cost effective because patients are being taught lessons for life and treatment is not prolonged (12-20 weeks).
RIGGS ET AL (2007)
INDIVIDUAL TREATMENTS ARE NOT EFFECTIVE.
- CBT has been criticised for focusing on symptoms rather than causes.
- By providing clients with strategies for self-help, they’re less manipulative than other treatments.
- It also relies heavily on patient dedication and therefore may not be appropriate for people experiencing severe depression if they lack motivation (possible eclectic treatment would be better).
- Use of CBT is based on the assumption that depression has a cognitive etiology, this using CBT as a treatment is reductionist as there may be other etiologies also including biological or sociocultural etiologies. Shown as there isnt 100% success of CBT.
EVALUATION OF INDIVIDUAL
- CBT has been heavily criticised for focussing too much on the symptoms, rather than causes, of depression.
- Most studies reveal that SSRI treatment is an effective form of treatment too- implying that while individual approaches are effective, other approaches can be equally as valuable.
- Relies heavily on self-dedication and may not be appropriate for those experiencing severe cases of depression, if they cannot motivate themselves to get involved.
- There are very few negative side-effects associated with CBT, and it is cost-effective. Therefore, may be considered a more desirable approach than biomedical, because it has almost equal success rates and does not involve artificial injection, nor negative impacts.
GROUP TREATMENTS
- Main form of group therapy is couples therapy, due to the strong link between depression and marital problems. These sessions focus on teaching couples to communicate and problem-solve more effectively, while increasing positive interactions.
- There is also mindfulness-based cognitive therapy (MBCT) which aims to prevent people relapsing after successful treatment. It is based on buddhist meditation and relaxation techniques which help people be able to cope with intrusive thought and prevents negative thought.
- These techniques aim to teach people to recognise the signs of depression, where thoughts can be viewed as ‘mental events’ rather thaan something central to their self-concept or as an accurate reflections of reality.
GROUP TREATMENTS ARE EFFECTIVE
Important factors in group therapy are:
1. Group cohesion: all people need to feel like they belong to the group (as this is a basic need of humans based on the sociocultural level of analysis)
2. Exclusions: should certain people be excluded.
3. Confidentiality: people must be able to trust that they can speak freely in the group
4. Relationship with the therapist: Therapist must show empathy for all members in the group and try to understand their reality.
- It’s a cost effective treatment as more than one person can be treated at a time
- Allows individuals to create a cohesive unit and help each other get better - the members of the group are invested in the welfare of each other.
MCDERMUT ET AL (2001)
GROUP TREATMENTS ARE NOT EFFECTIVE
This study shows how group treatment is effective, but is more effective when coupled with other methods
KUYKEN ET AL (2008)
EVALUATION OF GROUP TREATMENT
- A cost-effective treatment, as more than one person can be treated at once. This can be important for those who cannot afford individual treatment.
- Research has shown promising effects of MBCT in preventing relapse of depression.
• As Truax argues, in some cases, group treatment will not be effective, for example if the person does not have a positive attitude towards the treatment. Therefore, perhaps it shouldn’t be used with those who have severe depression. (Truax responded to this research by claiming that group therapy should only be used when the patient is positive about treatment in a group – meaning that if one is not positive about the group treatment, they will not be positively impacted by it. This may be a suitable explanation for the finding that 9 studies valued individual and group treatment equally.)
- However, it may be better when combined with medication (seen in kuyken)
COOK AND MINEKA
1990
Aim: To test whether monkeys can acquire fear responses by imitation of other monkeys, and to see whether they are more likely to learn fear of dangerous objects than non dangerous objects.
Procedure (1) - 22 lab rhesus monkeys (aged 4-11) observed a 32 year old wild monkey with a fear of snakes, responding to a snake. Then they watched a video where the fear response was shown with flowers (so it appeared that the monkey was afraid of flowers). Then they assessed the monkey’s fear to these things by recording the time it took to reach for food in presence of fear stimulus (e.g. toy snake, toy flowers)
Findings: Time taken to reach for food increased after watching videotape where fear stimulus was dangerous. From 9 to 27. But did not increase when flower stimulus was not dangerous.
Conclusions: They found it easier to condition monkeys to fear toy snakes than cuddly flowers. This is because a fear of harmful animals and situations would provide an evolutionary advantage and therefore be passed on, so they have a predisposition that can be triggered by the video.
EVALUATION
- There are a lot of extraneous variables for this study, for example they judged fear by the length of time that it took for a monkey to reach food and used a wide range of ages. Could it be that the 11-year-old monkeys are slower than the 4-year-old?
- A weakness of this etiology in general is that it cannot explain why individuals have phobias of stimulus that is not life threatening (phobias that would have no evolutionary advantage, e.g. buttons). It also does not explain social phobias.
Analyse cognitive etiologies of anxiety disorders?
PHOBIAS
COGNITIVE
Beck’s cognitive theory of emotional disorders (1976)
Beck argues that it is necessary to consider the internal mental processes of an individual in order to discover why some of us develop an anxiety (and other) disorders whereas many of us do not.
(Cognition precedes an emotional response, dysfunctional beliefs form early in childhood through the acquisition of dysfunctional schemas).
Beck argues that phobias as an anxiety disorder are caused by the formation of schemas which causes individuals to form an association between a stimulus and fear. It argues that anxiety characterised by vulnerability schemas, the perception of physical and psychological threat to oneself. A vulnerability schema develops from an early experience that forms dysfunctional beliefs about that event. Then a critical life event activates these assumptions, causing the symptoms of an anxiety disorder.
The emotions that we feel such as fear, are a result of our interpretations of our experiences according to existing schemas. Vulnerability schemas make people fear the object and this often leads to the development of phobias.
Anxiety is characterised by vulnerability schemas, the perception of a physical and psychological threat to oneself.
For example:
An early experience of a spider falling on you, leads to the formation of the dysfunctional belief that all spiders are dangerous, then critical life incidents occur and you come across a spider and your previous assumption is activated and you believe that this spider is dangerous. Then the way you process this information is biased and you believe you are helpless and then this gives you the symptoms.
Phobias are likely to:
- Over exaggerate the negative consequences
- Under estimate their ability to cope
- Show “catastrophic misinterpretation”
Phobics pay selective attention to threat cues:
This is shown with the STROOP TASK - which is when you tell people to identify the colour that the words are written in. Phobics take longer to name the colour of threat related words and are more likely to misinterpret ambiguous or neutral situations as threatening.
PERCEVED DANGER:
Nevid, Rathus and Greene, 1991. These individuals may also have cognitions that cause them to perceive danger in situations that others would consider safe. For example, persons with social phobias may dwell on their fear of embarrassing themselves or being rejected in situations where most people would not have these irrational and threatening cognitions. Another component of the cognitive model of social anxiety suggests that socially anxious people over predict the fear that they will experience when in a social situation. This could explain the avoidance behaviour that individuals with social phobias experience. There could be an overestimation of the anxiety response causing individuals to completely avoid social situations, when in reality their experience would not be catastrophic as expected.
NEGATIVE EVALUATION
Another cognitive etiology of phobias is the fear of negative evaluation, proposed by Watson and Friend (1969). This was defined as apprehension about other’s evaluations, distress over negative evaluations by others and the fear that someone will evaluate you negatively. Especially applies to social phobias.
RAPEE AND LIM (1992)
EVALUATION
- Better at explaining how phobias are maintained than why they appeared in the first place.
- Can be applied to social phobia and agoraphobia because of the emphasis on negative thinking about expectations.
- Treatments based on this approach (e.g. cognitive restructuring) have proved to be very effective.
- Still weak on why some people develop phobias when others in similar situations do not.
CONCLUSIONS:
To conclude there have been many cognitive etiologies in relation to phobias that have evidence to support them.
However cognitive etiologies do not offer explanation for an individual developing phobias in every situation, in other words not all phobias have cognitive causes.
Purely looking at cognitive etiologies of phobias is a reductionist approach in the sense that other etiologies, like biological and sociocultural etiologies are also argued to be involved in the development of phobias. Therefore, one should perhaps take a more eclectic approach, applying a combination of etiologies to the development of phobias.
NEVID, RATHUS AND GREEN
1991
Nevid, Rathus and Greene, 1991. These individuals may also have cognitions that cause them to perceive danger in situations that others would consider safe. For example, persons with social phobias may dwell on their fear of embarrassing themselves or being rejected in situations where most people would not have these irrational and threatening cognitions. Another component of the cognitive model of social anxiety suggests that socially anxious people over predict the fear that they will experience when in a social situation. This could explain the avoidance behaviour that individuals with social phobias experience. There could be an overestimation of the anxiety response causing individuals to completely avoid social situations, when in reality their experience would not be catastrophic as expected.
THIS IS USED IN THE COGNITIVE ETIOLOGY OF PHOBIAS.
Analyse sociocultural etiologies of anxiety disorders?
There is much less research available about sociocultural influences in the development of specific phobias, but there is research that indicates there are differences across cultures that must be accounted for somehow.
SOCIAL LEARNING THEORY
- This etiology is based on the theory that we learn behaviours through observation, imitation and vicarious reinforcement (learning through observation of the consequences of actions for other people).
- Phobias can be learned from the people around us and their fears. If someone displays physical symptoms of a phobia and is calmed down by another person, one may exert a similar behaviour if put in a similar situation.
- Example: A child watches a parent with a phobias of wasps panic and run in fear when one coms near them (observation). The child witnesses the parent then be calmed down by someone else and reassured (vicarious reinforcement). The child then reacts in a similar way when they are faces with a wasp (imitation) and hence they learn the same behaviour.
DUBI ET AL (2008)
MEMBERS OF DIFFERENT CULTURAL GROUPS TEND TO HAVE DIFFERENT PHOBIAS.
CHAPMAN ET AL (2007)
This suggests that phobias are transmitted inter-generationally.
INFLUENCE OF UPBRINGING AND SOCIAL AND CULTURAL EXPERIENCES
- Other sociocultural etiologies include social and cultural experiences, including the influence of upbringing.
- The influence of upbringing is the idea that a lot of individuals’ behaviours are influences by observing the acts and behaviours of their parents. This links to the social learning theory explored in Dubi et al.
- Social and cultural experiences are also argued to lead to an increased chance of developing phobic symptoms and therefore a higher chance of developing a phobia. These experiences can be culture specific or experiences related to social relationships.
IANCU ET AL (2007)
Although this cannot show exactly how this engenders the development of specific phobias some suggestions are offered by Chapman et al (2007).
EVALUATION
- The research on upbringing is correlational and relies on people’s memory which can be inaccurate.
- Other factors may be responsible e.g. some people may have a biological pre-disposition that makes them more likely to develop phobias.
IANCU ET AL
2007
Aim: He investigated the prevalence of specific phobias among 850 Israeli youths of both genders recruited into schools for military medicine or mechanics.
Findings: They found that phobic symptoms were more present among males, specifically those who had not graduated high school, those not in romantic relationships and those with less and two good friends.
The researchers suggest that Israeli youths live in masculine and high stress psychological atmosphere. This may lead to higher levels of anxiety, which would cause increased fear responses to certain things and hence may cause phobias.
CONCLUSION:
- In this case it seems that friendships and relationships are a protective factor against the onset of phobias. An explanation for this is that sharing anxieties with close relations provides the opportunity to relieve the anxieties - a lack of close relations may lead to phobic symptoms which will intensify and manifest more clearly.
Although this cannot show exactly how this engenders the development of specific phobias some suggestions are offered by Chapman et al (2007).
CONC:
To conclude, there have been many sociocultural etiologies in relation to phobias that have evidence to support them
- However sociocultural etiologies do not offer explanation for an individual developing phobias in every situation, in other words not all phobias have sociocultural causes
- Looking purely at sociocultural etiologies of phobias is a reductionist approach in the sense that other etiologies, like biological and cognitve etiologies are also argued to be involved in the development of phobias. Therefore, one should perhaps take a more eclectic approach, applying a combination of etiologies to the development of phobias
CHAPMAN ET AL
2007
Procedure: They compared African and Caucasian Americans with regard to the types of specific phobia experienced.
Findings: They found that African Americans held more fears, with the greatest number grouped in the natural environment category (e.g. fear of deep water or storms) whereas Caucasian Americans tended to hold most fear over situations (e.g. public speaking or flying).
DUBI ET AL
2008
Aim: To investigate whether social learning theory plays a role in phobias.
Procedure: Observed toddlers (15-20 months) showing fear and avoidance of fear-relevant objects (rubber spiders) and fear irrelevant objects (rubber mushrooms) after having observed their mothers display negative and fearful reactions to both objects.
Findings: The toddlers showed increased fear and avoidance of the objects following negative reaction from their mothers than following positive maternal expression for both. This suggests that phobias may be formed by social learning (and also links to the parents as an influence).
EVALUATION:
- Findings cannot be generalised to the wider population as this study only demonstrates the social learning theory based on the relationship between a mother and her child, therefore it cannot suggest social learning theory as an etiology of phobias in every individual
- does not suggest how people develop phobias for objects when they do not know anyone else with a similar phobia. Also, the little research there is into this area lacks ecological validity due to laboratory set-ups.
Sullivan et al
2000
Aim: To investigate the genetic predisposition and genetic inheritance of major depression.
Procedure: A meta analysis of relevant twin studies was conducted, including 21000 twins.
Findings: Researchers found that monozygotic twins were more than twice as likely to develop major depression if their co-twin had the disorder compared to dizygotic twins. On average, the study showed that genetic influence in developing major depression was between 31% and 42%. The study also showed that non-shared environmental factors were important.
Conclusion: This study can show support for the hypothesis that genetic factors might predispose people to develop depression.
Evaluation: The fact that the concordance rate for MZ twins is far below 100 does not contradict the argument that depression is genetically inherited but it indicates that depression may be the result of other factors as well as genetics.
- The meta analysis holds benefits and disadvantages as it has gathered a great deal of information, but some of the methods within some of the studies may have been invalid or unreliable.
Caspi et al?
2003
Aim: To examine the role of the 5-HTT in Major depressive disorder, relating to serotonin transmission, as this gene is involved in the re-uptake of serotonin in the brain synapses. It was suspected that adaptations in this gene would reduce the amount of serotonin available, with lower levels of serotonin affecting the incidence of depression. Caspi predicted that individuals with 2 short 5-HTT genes are more likely to develop major depression after a stressful event.
Procedure: Researchers looked at DNA samples from 127 individuals who were part of a long term study of mental health.
Findings: It was discovered that those with the short short combination of alleles experienced higher levels of depression after a stressful event than those with the other who combinations.
Conclusions: The conclusion was made that the combination of short short was related to depression because it reduces the effectiveness of serotonin transporters.
Evaluation
- Action/involvement of other genes cannot be controlled during investigation
- Self reporting of symptoms can be un-reliable
