Abnormal Studies

Question 1

Kuyken et al

Answer 1

2008
This study shows how group treatment is effective but is more effective when coupled with other methods.

Aim: To investigate the effectiveness of Mindfulness-Based Cognitive Therapy. Looking at the combination of SSRI’s and group-based treatment as an eclectic approach.

Procedure: Randomised controlled study with 123 participants with a history of depression. All were prescribed with the same anti-depressive medication and then allocated to either the control condition (continued with the medication) or experimental condition (participated in MBCT as well)

Findings: Those in the control group had a relapse rate of 60% compared with 47% in the experimental group. Those in the MBCT group reported an overall higher quality fo life, in terms of physical well-being and daily enjoyment.

Conclusion: This research shows how combining treatment improves the effectiveness of the whole treatment programme.

Evaluation:
- The validity of the results may be limited, due to the risk of social desirability biasing the results. − It could be that participants reported a higher quality of life because they think that that is what they are expected to say or that it is what they should say. Therefore, to be able to validate the conclusion, more research confirming the findings should be conducted.

− There is still a relapse rate of 47% in the experimental condition, which one may argue is too high to consider eclectic treatment an effective way of treating depression. Nonetheless, a counter argument to this would be that 50% of all people who treat depression relapse, and so the numbers are not too different.

Question 2

Mcdermut?

Answer 2

2001

Aim: To investigate the effectiveness of group treatment (MBCT) in treating depression.

Procedure: They conducted a meta analysis based on 48 studies between 1970 and 1998. The participants’ mean age was 44 years old and 78% of patients were women. All but one study included a CBT treatment group.

Findings: 45/48 studies reported that group psychotherapy was more effective than no treatment around 19 weeks after the end of treatment. 9 studies showed that group and individual treatments were equally effective.

Conclusions: This study was able to provide sound support that group therapy for relieving depressive symptoms.

CRITICISMS: 78% of the study were women and the mean age was 44 and so this study cannot be generalised to the wider population. It doesnt tell us very much about depression in males or different aged people.
Also the meta analysis didnt include severely depressed patients so conclusions cannot be made on these groups of people.

Question 3

Riggs et al

Answer 3

2007

Aim: To investigate the effectiveness of CBT on depressed adolescents, many with additional substance abuse.

Procedure: Conducted a study using 126 depressed adolescents aged 13-19 recruited from social services and juvenile justice systems (who clinicians were hesistant to prescribe drugs to as they though they may abuse the use of these drugs). The participants were randomly assigned to a condition of either CBT and a placebo, or CBI and SSRI. Most complied with the study, but some couldn’t be followed up as 2 withdrew and 12 relocated or went to jail. A physician rated the improvement of patients through a double blind experiment.

Findings: The physician found that 67% of patients in the CBT and placebo group had improved after 4 months and 76% in the SSRI and CBT group.

Conclusions: These results showed while the best results came from CBT and SSRI, CBT group was also effective, suggesting it was a good treatment for depression.

EVALUATION
Researcher bias and participant expectations were avoided as the experiment was double blind. This means that the findings are likely to be genuine and therefore, the conclusion more valid.

Question 4

Neale et al

Answer 4

2011

Aim: To investigate the effects of antidepressants

Procedure: He conducted a meta-analysis on patients on antidepressants who changed to a placebo, patients only on a placebo and patients only on antidepressants.

Findings: He found a 25% relapse in patients not on anti-depressants, compared to higher than 42% relapse for patients on medication that then stopped.

Conclusion: He concluded that this increase may have been seen because anti-depresseants could interfere with the brain’s natural self-regulation, reducing symptoms in the short term, but when you stop taking them, depression may return because the brain’s natural self-regulation is disturbed so this study demonstrates the ineffectiveness of antidepressants.

Evaluation:

• The findings are not entirely valid - because conducting a meta-analysis means that there are likely to be many extraneous variables. The conditions are controlled factors for each of the analysed studies are likely to differ, which may have had profound impacts on the findings - and hence also on the conclusions made in the meta-analysis. Therefore, while the study provides insight, it does not accurately demonstrate the effectiveness of SSRI’s as a biomedical approach to treatment.
• Would support the idea put forward by Kirsch that antidepressants are ‘over prescribed’ due to their income-potential. Over 16 million prescriptions annually in the UK are for SSRI’s, implying that doctors must think they’re effective, despite research suggesting otherwise.

Question 5

TADS

Answer 5

2007
- Another study that looks into serotonin levels as a biological etiology of depression. It is the work of the National Institute of Mental Health.

Aim: To examine the short and long-term effectiveness of drug treatment in treating depression of adolescents aged 12-17.

Procedure: 13 clinics in the USA were involved with the trial and all over the project cost 17 million dollars. 439 participants (diagnosed depressive adolescents) from 13 US clincs were randomly assigned to one of the four groups (1) fluoxetine (2) placebo (3) CBT (4) fluoxetine and CBT. The effectiveness of the treatment was measured using a standardised depression scale which looked at a reduction in the symptoms and also the relapse rate.

Findings: Within 12 weeks, the placebo had the lowest response rate of 35% compared with a response rate of 61% for those that took fluoxetine. This increased to 69% in 18 weeks and 81% in 36 weeks. However, in the long term, CBT also had an 81% success rate in 36 weeks. The highest response rate (86%) was those taking fluoxetine and CBT.

Conclusions:
- Fluoxetine (SSRI) reduced depression by up to 81% over the 36 weeks, which suggests that its an effective treatment for depression. HOWEVER, CBT was just as effective long term.

• The high response rate associated with fluoxetine suggests that depression may be caused by low levels of serotonin. However, CBT was just as effective, which raised the question as to whether depression really is caused by low serotonin. It could be argued that CBT, which aims to reduce depressive symptoms works to also increase serotonin levels as the symptoms become less significant, and hence there is a link.

EVALUATION

• 12 weeks may not be a long enough period of time to be able to observe the complete effect of treatment plans, perhaps researchers should observe for longer to see if there were any long term benefits of some of the treatments over others.
• There was only a 5% difference between the response rate for CBT+fluoxetine and each separately. This is a relatively small difference, which would suggest that the difference may be purely due to chance. It would also suggest that it is equally as effected to be treated by one of them. Therefore, while the study does imply that an eclectic approach is more effective, one must accept that due to the nature of the research it could be due to chance.
• This may reflect the treatment - etiological fallacy (the mistaken notion that the success of a given treatment reveals the cause of the disorder). It may be the other factors, other than biochemical influences, have improved one’s depressive state, such as social support or changes in cognition. If one is diagnosed with depression and issued anti-depressants such as fluoxetine, it is likely that their social network will improve as people appreciate the severity of the situation and try to help as much as possible. Therefore the relationship between serotonin levels and depression can only be suggested.

Question 6

Rapee and Lim

Answer 6

1992

Rapee and Lim (1992) found that social phobic individuals show a sense of lack of control, biased expectations and negative evaluations that could stem from early developmental experiences.

Aim: To investigate fear of negative evaluation.

Procedure: In their study they had social phobia patients and control participants present a brief, impromptu speech. The audience then rated the performances of both.
Findings: There was no difference between the audience’s ratings of the control and the social phobic participants. However those with social phobia rated their overall performance as worse than the controls did.

Conclusion: These findings suggest that persons with social phobia may perceive their performance more negatively than others. Even when others perceive their performance as adequate, social phobic individuals might have negative evaluations of themselves. This study shows how fear of negative evaluation may be a cause of social phobias, suggesting this as a cognitive etiology of phobias. If one is scared of how others will respond to their behaviour or actions, and believes that they will evaluate them in a negative way, this may cause a more severe fear to form - a social phobia.

EVALUATION:

• Ethical issues as it puts participants under undue stress and harm
• Weakness of this etiology is that although it explains social phobias, as it relates to the social pressures people may have in situations, it cannot explain all types of phobias where other humans are not involved, for example the fear of inanimate objects

Question 7

Villa and Burmeister

Answer 7

2003

Aim: To determine what, if any, genetic causes can be identified for anxiety disorders, specifically agoraphobia.

Procedure: Reviewed several linkage studies that have been published that identify loci involved in normal variation in anxiety and/or that predispose to several anxiety disorders.

Findings: In the case of agoraphobia, first degree relatives are also at increased risk of an anxiety disorder, indicating a possible genetic link between agoraphobia and phobias as an anxiety disorder. Monozygotic twin studies showed that when one twin has agoraphobia, the second twin has a 39% chance of developing the same phobia. When one twin has a specific phobia, the second twin has a 30% chance of developing a specific phobia. This is much higher than the 10% chance of developing an anxiety disorder found in the general population.

Conclusion: It seems that genes definitely play a role in the formation/causes of phobias as an anxiety, disorder. However since the concordance rates are not 100% there must be some other factor which can cause them.

EVALUATION:

• This investigation assumes that all of the studies were standardised and used the same procedure, when in reality this probably is not so. Therefore the extent to which study study demonstrates the role of genes as an etiology for phobias is limited.
• A criticism of this etiology can be the same as biological preparedness, that genes cannot explain why some people develop phobias when they have no genetic reason to.

Question 8

Mendel et al

Answer 8

2011

Aim: Carried out a more modern study to investigate confirmation bias in diagnosis.

Procedure: Researchers gave a case study to 75 psychiatrists and 75 fourth year medical students. Participants were asked to give a preliminary diagnosis of depression or Alzheimers disease and to recommend a treatment. The vignette was designed so that depression would seem the most appropriate diagnosis. Participants could then opt to view up to 12 pieces of further information.

Findings: For the preliminary diagnosis 97% of the psychiatrists and 95% of students chose depression. After looking at the further information, 59% of psychiatrists and 64% of students reached the correct diagnosis of Alzheimers disease. Psychiatrists who did not use information effectively to diagnose and only looked at information that confirmed their original diagnosis were less experienced. Participants were more likely to make the wrong final diagnosis if they chose to view 6 or fewer pieces of additional information.

Conclusion: This study is interesting because it seems to indicate that confirmation bias is not as serious a concern as we would think. However, 40% of doctors confirming their original incorrect diagnosis is still pretty significant.

CONCLUSIONS:

• Recent 2011, so diagnostic material is similar to what we use now.
• Low ecological validity. This is because it is a laboratory experiment and even though reading case studies is sometimes part of diagnosis, the task used is not typical of an every-day situation as there is no patient examination/ the participants were given only two choices for diagnosis. This means that while the study demonstrates how confirmation bias is a relevant ethical consideration in artificial circumstances, it does not show the relevance of this ethical consideration in real life diagnostic situations.

Question 9

Langer and Abelson

Answer 9

Aim: To test the theory of labelling and stigmatisation with psychiatrists as the participants.

Procedure: The psychiatrists watched a video of a younger man talking to an older man with the sound removed. Following this, researchers told half of the psychiatrists that the younger man was a patient and the other half that he was a job applicant. They were then asked questions about the young man.

Findings: Those who were told that the man was a job applicant described him with positive words such as attractive and confident. However, those who were told that he was a patient described him more negatively, using words such as defensive, aggressive and frightened.

Conclusion: Being labelled as a ‘patient’ led to stigmatisation in the sense that the man was described to be behaving in a more negative way.

Criticisms:
- This study has low ecological validity as a laboratory experiment was used and so the tasks performed as part of the study were outside of a natural setting. The psychiatrists were asked to simply form a judgement based on a video, when in a real-life context, this kind of activity would involve patient examination. Therefore, while this study demonstrates that there are ethical considerations relating to stigmatisation and labelling that should be considered in diagnosis, it does not show us whether these problems occur in real life diagnostic settings.

• The participants are being asked to make a decision based on very limited data so it is not surprising that they use the labels they were given.

This shows that labelling has control over the way that people are perceived and treated.

Question 10

Kleinman

Answer 10

1984
He studied the somatisation of symptoms in Chinese depressive patients. He argued that it’s impossible to compare depression cross culturally because it may be experienced with substantially different symptoms or behaviours e.g. lower back pain (China), or feelings of guilt (Western).

This makes it difficult for clinicians to accurately diagnose and suggest treatments. Perhaps the reason for the difference in symptoms could be due to the cultural characteristics of collectivist and individualist societies.

Those from a collectivist society often live in extended families and have strong social bonds. The needs of the group are the most important. If an individual has depression within this culture then they may be able to reduce the emotional symptoms by using their strong social support networks to help them. If their strong social support is helping to ease the symptoms of sadness or guilt then it would make sense that they would become more aware of their physical symptoms.

On the other hand in individualist cultures such as the UK and USA our healthcare system is particularly developed and individuals are encouraged to seek medical help when it is needed. When we have a headache or backache we are encouraged to take some tablets to reduce the pain, which might explain the reduction is somatic symptoms. However, in individualist cultures the emphasis is on the individual and their own success, so there are less opportunities for strong social bonds and group harmony. This may be why they report more emotional symptoms because they do not have the support needed to deal with it.

As a result clinicians need to take into account the cultural norms of an individual to identify the ways in which they might need support relative to their culture. Therefore, socio-cultural differences in the prevalence of depression may reflect the statistical likelihood of seeking professional help for emotional states.

Question 11

Li-repac

Answer 11

Aim: To test the role of cultural stereotyping in diagnosis.

Procedure: Li-Repac compared the diagnoses of 5 European American (white) therapists and 5 Chinese American therapists on 5 European and 5 Chinese male subjects.

Therapists carried out semi-structured videotaped interviews with each of the patients. They were asked questions like “how have you been feeling lately” and “how do you spend a typical day”.

Findings:

• White therapists were more accurate in predicting self descriptive responses of white patients than the Chinese.
• There were significant differences between ratings of same clients given by 2 therapist groups. Chinese patients were higher on a “depression/inhibition” cluster but lower on a “social poise/interpersonal capacity” cluster by white therapists than the Chinese-American therapists. Chinese-American therapists considered the white patients more severely disturbed than the white therapists did.

Conclusion: These differences were interpreted as reflections of therapists cultural biases of mental illness, as well as their own world view. As a result of cultural differences, the clinicians perceived the abnormal traits differently.

Criticism:
o Low population validity and historical validity- This is because the study only included male patients and was conducted in the 1980s.
o It could be the case the culture doesn’t affect the diagnosis of women as much as it did for males in this study.
o In addition, clinician’s understanding of culture has changed massively since the 1980s, and there are more reliable diagnostic assessment tools available now.
o Therefore, this study doesn’t inform us about whether culture is being considered similarly in diagnosis nowadays, and whether cultural consideration is being applied to the diagnosis of female patients.

OVERALL SHOWS US IT IS IMPORTANT TO CONSIDER CULTURE.

Question 12

Mitchell et al

Answer 12

2009

Aim: To test the validity of diagnosing depression.

Procedure: A meta analysis was conducted, using data from 41 clinical trials (with 50,000 patients) where semi-strucutred interviews were used by GP’s to investigate and determine the mental health of patients in relation to depression.

Findings: Through watching the GPs participating it was clear many of the GPs struggled forming a correct diagnosis. General practitioners had 80% reliability in identifying healthy individuals and 50% reliability in diagnosis of depression and many GPs were more likely to identify false positive signs of depression after 1st consultation.

Conclusions: Mitchel argued that GP’s needed to see patients at least twice before diagnosis was made since accuracy of diagnosis was improved in studies that used several examinations over an extended period.
this study demonstrates the importance of validity in diagnosis to reach the correct conclusion, especially as diagnosing a person with depression can have detrimental effects on their life in the form of stigmatization due to this label.

CRITICISMS:
• This study has high population validity because of the meta-analysis using data from all over the world, this makes the findings representative of a large sample and hence generalisation is possible to the general population. Therefore, the study provides great insight into how GPs specifically can increase the validity of their diagnoses.
• Limitations of meta-analysis are that it may suffer from problem of publication bias- since data from many different studies are used there may be problems of interpretation of data because it is not certain that each study uses exactly the same definitions

Question 13

Cooper et al

Answer 13

1972

Aim: Cooper aimed to investigate the reliability of the diagnosis of depression and schizophrenia in 1972.

Procedure: The researchers asked American and British psychiatrists to diagnose patients by watching a number of videotaped clinical interviews between other psychiatrists and these patients.

Findings: There were strong differences in how the British and American psychiatrists diagnosed the patients. British psychiatrists diagnosed patients as being depressed twice as often as the Americans did and American psychiatrists diagnosed patients with schizophrenia twice as often as British psychiatrists.

Conclusion:
The results indicated that the same case didn’t result in similar diagnoses in the two countries. This suggests that there may be problems with inter-rater reliability as well as cultural differences in the interpretation of symptoms, such as the different cultures picking up on different things.

these findings highlight a lack of consistency in their diagnosis and hence emphasises the issue of unreliable diagnosis.

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.

Question 14

Rosenhan

Answer 14

1973

Aim: To illustrate the problems involved in determining normality and abnormality and the poor reliability of diagnostic classification systems for mental disorders.

Procedure: Researchers conducted a covert (secret) participation observation with 8 sane participants. 5 men and 3 women, including Rosenhan. The task was to follow the same instructions and present themselves in 12 psychiatric hospitals in USA- under fake names and occupations. Participants were told to report hearing same sex voices that said simple words such as ‘empty’ ‘hollow’ and ‘thud’. On admission to the hospital, every ‘pseudopatient’ stopped simulating any symptoms and responded normally to all instructions and said they were experiencing no more symptoms.

Findings:

• All participants were admitted to various psychiatric wards and all but one was diagnosed with schizophrenia. The last one was diagnosed with manic depression.
• They made notes but these were taken by the doctors as symptoms of their disorders.
• It took between 7 to 52 days before participants were released. The average stay length was 19 days.
• All except one came out with the diagnosis of schizophrenia in remission.

Conclusions: Labelling a participants as schizophrenic can lead to other, normal behaviours being interpreted as schizophrenic behaviours, which demonstrates stigmatisation. The study showed reliability in diagnosis (all the doctors said the same), even though it was an incorrect diagnosis which demonstrates the difficulty in diagnosing mental disorders.

STRENGTHS

• 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
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.

Question 15

Fitzpatrick

Answer 15

1993

Aim: To investigate the exposure to violence and presence of depression among low income, African American youth.

Procedure: 221 low income African American youths (aged 7-18) took the Children’s depression inventory.

Findings: Younger children and those living in motherless households reported more depressive symptoms. Those who had experienced levels of violence also reported more depressive symptoms. However, chronic exposure to violence, in form of witnessing violent acts as opposed to being the victim was not significantly related to depression.

Conclusion: Therefore, it can be concluded that sociocultural factors of being a victim of violence, and the lack of a mother figure whilst growing up seems to lead to symptoms of depression.

Evaluation:

• Lacks historical validity as the research was conducted in 1993, as there is more violence in the world now, there may be a change in the results as individuals may be affected by their experiences differently.
• Only African-American cannot generalise.
• This only links to symptoms of depression and not being clinically diagnosed so you could argue that it is not an etiology.

Question 16

Farb et al

Answer 16

2011

Aim: To measure rumination in individuals who had already suffered from depression, to see if rumination predicted a relapse later on.

Procedure: Researchers showed 16 formerly depressed patients sad and neutral films and tracked their brain activity using and fMRI. They compare the fMRI’s to 16 healthy controls. Participants were then left for an 18 month follow up period. After this period, researchers calculated the correlation between emotional reactivity in response to the films and subsequent relapses during the 18 month period.

Findings: 10 out of the 16 people relapsed during the 18 month period. When faced with the sad film the participants who relapsed had higher activity in the frontal region of the brain, linked to rumination.

Conclusion: Depressed patients show higher activity in the frontal parts of the brain which are associated with rumination. Ruminating in order to analyse and interpret sadness, may actually be an unhealthy reaction that can perpetuate the chronic cycle of depression. So rumination is seen to influence depression.

Evaluation:

• Study may lack validity due to the small sample size, so results are difficult to generalise to the wider population.
• Study also looks at correlation between depression and rumination so cause and effect cannot be established from this, so it cannot be concluded that rumination causes depression it may just be a characteristic of someone who is depressed.

Question 17

Alloy et al

Answer 17

1999

Aim: To investigate if one’s thinking patterns can be used to predict the onset of depression (to support Beck’s theory).

Procedure: Researchers conducted a longitudinal study in which they followed a randomly selected group of young Americans for 6 years. Their thinking style was tested at the beginning of the 6 years with methods including a questionnaire and the participants were categorised into two groups of positive cognitive (low risk) group and negative cognitive (high risk group) accordingly.

Findings: After 6 years, 1% of the positive cognitive group had developed depression compared to the 17% in the negative thinking group.

Conclusions: From the results, researchers were able to suggest a link between negative thinking was a cause of depression. From this study it is not clear whether negative thinking was a cause of depression or a characteristic of someone who is depressed and therefore it could not be a study on etiologies at all. But it could demonstrate the influence of cognition on depression, as people with more negative thinking were more predisposed to developing depression.

Evaluation:
- More research is needed to conclude the extent of the influence as not everyone in the negative cognitive group developed depression and depression was seen in the positive cognitive group.

• The questionnaires may not be a measure of cognitive thinking/style so some individuals may have been allocated to the wrong group.

Question 18

Brown and Harris

Answer 18

1978

Aim: To determine the role of environmental factors in the onset of depression in women.

Procedure: A case study was conducted where researchers conducted semi-structured interviews with 458 women in London about biographical information and the difficulties they have faced.

Findings: 37 women (8%) had become clinically depressed in the previous year and 33 of these 37 women having experienced an adverse life event (e.g. loss of a loved one) or a serious difficulty (e.g. an abusive relationship). Only 30% of the women who did not become depressed experienced an adverse life event.

Conclusion: This led Brown and Harris to suggest a vulnerability model of depression based on a number of factors that could increase the likelihood of depression. These factors fit into three categories; protective factors (factors that decrease the likelihood of depression alongside major stressful events). vulnerability factors (factors that increase the likelihood of depression alongside a major stressful event) and provoking agents (acute and ongoing stress).

Evaluation:

• gender bias
• case studies cannot be generalised to the wider population
• not just social stressors as not all

Question 19

Caspi et al

Answer 19

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

Question 20

Sullivan et al

Answer 20

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.

Question 21

Dubi et al

Answer 21

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.

Question 22

Chapman et al

Answer 22

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).

Question 23

Iancu et al

Answer 23

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

Question 24

Cook and Mineka

Answer 24

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.